Extraction, Immediate Implant Placement, Veneer Provisional

LomaLindaUniversity
Patient Presentation Seminar
PATIENT
PRESENTATION
Prepared by Dr. ChauLong Nguyen, DDS, MAGD
November12, 2015

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Healed Site
Immediate Loading
Veneer Provisional on Abutment
Dr. auLong Nguyen
DDS, MAGD

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My office- reception desk to the left

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Reception Area & Hall Way to Treating
Rooms
We have 16 windows around the office.

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Treating rooms

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Why most Africans have white teeth?
In November 2013, I went to Africa for safari
gaming tour in Boswana, Cape Town South
Africa, Zimbabwe, and Zambia for a month.
Behind the elephant is the toothbrush
tree/bushes.

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Receptioin area Chobe National Park

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Toothbrush tree= Salvadora persica
Sal

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Toothbrush tree= Salvadora persica
From Wikipedia, the tree encyclopedia
It is also known as Arak, Pilu, mustard tree. It is a species of Salvardora. Salvadora
persica has antiurolithatic (anti-urinary stone/calculi) properties. It is used for centuries
as natural toothbrush. Its fibrous branches have been promoted by World Health
Organization for oral hygiene use. Researches suggest it
contains a number of medically
beneficial properties including abrasives,
antiseptics, astringent, detergents,
enzyme inhibitors, and Fluoride.

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Salvadora Perci=sica = toothbrush
Salvadora persica= toothbrush tree

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Patient Demographics
• Gender: female
• Age: 67
• Race: Caucasian
• Marital Status: Single
• Employment Status:
Administrator assistant at
Stanford University

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Frontal & Profile View At rest
Ms. Sue

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Smile in Frontal and
Profile View

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Chief Complaint
“I had 4 dentures for this tooth
and many bonded procedures
but it didn’t stay. I want to
have something fixed.”

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Medical History
• BP 99/47; P= 67
• ASA II
• Patient has asthma, arthritis,
hypertension, stomach ulcers,
gout

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Medical History
She is taking
1.Amlodipine
2.Lisinopril
3.Pentoprazole
4.Vitamin B12
5.No Inhaler
6.Allergic to Benzocaine

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Dental History
• Sue has several gold and PFM crowns and root
canal therapy in posterior teeth. They are all in
good conditions.
• Teeth #s 14 & 15 have extensive recurrent caries
with guarded to poor prognosis so she wanted to
wait until they bother her then take care of them.

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Dental History
• Acquired missing Tooth # 11 has adequate bone
volume BL = 7mm; MD = 8mm; inter-occlusal
space = 5mm;
• Cusp tips of #s 21 & 22 would be reduced to give
1mm of interocclusal space.
• Type III bone

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Anterior View

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Protrusive View

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Occlusal Views

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Maximum Intercuspation Views
Right Left

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Working Side Views
Right Left

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Extra-oral Findings
• Head and neck: WNL
• Facial asymmetries:
None
• TMJ: Normal,
healthy
• Lymph nodes:
nonepalpable

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•Soft tissue exam: mild to
moderate gingival inflammation
around all molars
Intra-oral Findings

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• Hard tissue exam: moderate
bruxism with uniform wear on
enamel and crowns of all teeth
• Missing tooth # 11
• Several posterior teeth have
gold and PFM crowns.
• Moderate to severe recurrent
caries in #s 2M, 18M, 14DB,
#15 M.
Intra-oral Findings

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• Occlusal Scheme:
• Angle Class I occlusion
• Skeletal class I.
Occlusal Findings

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Perio Exam
09/01/15

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• AAP: Generalized healthy with
localized chronic mild to
moderate gingivitis around all
molars.
Periodontal Findings

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Radiographic Presentation
June 26, 2015

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June 26, 2015

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• Acquired missing tooth # 11 causes esthetic
and functional problems.
• Type III bone
• BL= 7mm
• MD= 8.5mm
• Inter-occlusal space = 5mm
• Mild to moderate bruxism
Diagnosis

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• Good to excellent for implant
• Fair to Good for prosthesis due to mild to
moderate bruxism
Prognosis

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• 1. Take photos, xrays, scan, take bite registration & alginate impression
for tx plan presentation
• 2. place implant Nobel Biocare 3.5mm*10mm
• 3. Immediate placement of Ti-esthetic custom abutment
• 4. Reduce cusp tips of #s 21 & 22 for proper occlusal clearance
• Take bite registration, final impression with PVS and send to lab
• 5. Make bonded provisional veneer with sand blasting F of abutment
• 6. Deliver crown by cementation; Night Guard
Proposed treatment plan

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Implant and immediate veneer provisional
placed on 8-11, 2015 X-ays of
Implant placed 8-11,
I1 week post op 8-18- 2015

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Custom abutment placed 8-11, 2015

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Provisional veneer, 9-1, 2015

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Provisional veneer placed 8-11, 2015
Provisional veneer placed on 8-11-2015 Outof
occlusion

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Provisional veneer placed 8-11, 2015
Out of occlusion

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Lily in the Okavango Delta River

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• Sand Blasting abutment for final cementation
Abutment after provisional was
removed

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PFM crown was cemented on September 1, 2015
FiNnal PFM crown placed 9-1, 2015
Out of lateral excursion

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CBCT Radiographic Presentation
October 19-2015
2 month 8 days after Implant placement

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CBCT Scan

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Follow up post placement of PFM crown on
November 6, 2015

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Mauna Laani Coconut grove
r

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• An exposed root is my ideal
surgical guide.
Extraction,
Immediate Implant Placement

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• Gender: male
• Age: 86
• Race: Korean
• Marital Status: Married
• Employment Status: Retired
English Professor

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Front View at Rest and Smile
Mr. Kim

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Profile View at Rest and Smile

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Chief Complaint
“My bridge is loose. I have many
old gold crowns. I want strong
teeth to chew. Fixed whatever
you think wrong.”

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Medical History
1.BP= 136/87; P= 67
2.ASA I
3.Pt has hypothyroidism &
Gastroesophageal reflux disease-
GERD.
4.He is taking Levothyroxine &
Femetidine.

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Dental History
Pt has failed PFM bridges #s 2 to 4 & 11-15;
•Teeth #s 19, 31 have recurrent caries under gold
crowns
•Pt wanted to have successful implants placed for
#s 11, 12, 14 in 2006
•He would like to have teeth #s 2, 3, 4, 19, 31
implants and crowns.
•Pt has fair oral hygiene but doesn’t floss often.

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Occlusal View

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July 10, 2006
July 10, 2006

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• Bridge #s 11 -15 was removed and sectioned.
• # 15 PMF was re-cemented.
• Implants were placed for teeth #s 12, 14 on
September 15, 2006 & # 11 on December 1st
,
2006.
Pano was taken on August 15, 2006

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• 12- 1, 2006 9-16-2015
9 Years Comparison

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• 8-15-2-06 9-16-2015
9 years post Implant & prostheses
placement

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• Teeth #s 2, 4, 15, 19, 31 were removed and
implants were placed immediately at
extraction time
• Puros cancellous particulate bone graft
• There was no primary closure of gingiva at
extraction site
• Used chromic resorbable gut interrupted
sutures
Implants placed on
7-31, 2014 & 9-16, 2015

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January 16, 2014

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• 3-24-2014 9-16-2015
1.5 Years Post Extraction, Immediate
Implant Placement #s 2 & 4

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• Annual Recall visit 9-16-2015
Extraction and Immediate Placement
of # 31 on 9-24-2015

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• 1. Abscence of infection 2. Soft tissue Closure
• 3. Space maintenance 4. Graft Stability
• 5. RAP= Regional Acceleratory Phenomenon
• 6. Host Bone blood supply 7.Growth Factors
• 8. BMP=Bone Morgenetic Proteins
• 9. Healing time
• 10. Defect size and tophography
• 11. Transitional prostheses
Surgical Keys to Bone Grafting
Carl Misch- 3rd
Edition-Chapter 36-page 839

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•An exposed root is my ideal
surgical guide.
•Puros Cancellous Particulate
bone graft & Biomend
membrane
Extraction,
Immediate Implant Placement

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• Gender: male
• Age: 63
• Race: Iranian
• Marital Status: Married
• Employment Status:
Mechanical engineer

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Front View at Rest and Smile
Mr. Riazati

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2-2-2015; #s 12, 13

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2-2-2015; # 19

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2-2-2015; # 31

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7 month post implant placement

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7 month Post Implant, healing cap
removed from # 19

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• 2-2-2015 9-4-2015 11-6-15
• Teeth #s 12, 13
Extraction, Immediate placement, a
predictable result

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• 2-2-2015 9-4-2015 11-6-15
• Tooth # 19
predictable result

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• 2-2-2015 9-4-2015 11-6-15
• Tooth # 31
predictable result

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• MIP-Right side
• After Implant and prosthesis
Post-Prosthetic delivery
PFM # 31

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• MIP-Left side
• After Implant and prosthesis
Post-Prosthetic delivery
PFM #s 12, 13, 19

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2-2-2015, 9-4-2015, 11-6-2015

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11-6-2015, Post PFM crown delivery

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• I wish you all peace and happiness.
Thank you for your attention.

Extraction, Immediate Implant Placement, Veneer Provisional

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