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    How to provide full-mouth reconstruction with dentures and overdentures

    Why overdenture treatment is a good option for patients who may be anatomically or financially compromised.

    Advances in clinical techniques and materials continue to revolutionize dentistry, enabling clinicians to practice with a greater degree of predictability and confidence than ever before.

    Also, with increasingly affordable dental implants, more and more patients are opting for some form of implant therapy, whether fixed or removable. Utilizing not only the savings in dental implants, but also advancements in dental materials, clinicians are reporting reduced chair time and increased patient satisfaction when reconstructing patients’ smiles. This case study focuses on the sequences involved in the edentulation of the affected dentition, grafting these areas to build the foundation and final implant overdenture reconstruction.

    Case description

    A patient presented to my practice for a consultation, wanting to restore her dentition to proper form and function. She complained of generalized discomfort in these teeth due to the gross caries and periodontal disease that were readily apparent (Fig. 1). There were several teeth in both arches that were already removed due to gross decay and/or periodontal disease.

    Fig. 1Fig. 2

    Fig. 1                                                                                 Fig. 2

    Planning

    A CBCT scan using the CS 8100 3D (Carestream Dental) was taken to accurately capture the information needed to properly create a treatment plan for this case, ensuring the most ideal outcome since the patient discussed her frustration with previous treatment.

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    To further develop a treatment plan, digital impressions and bite registration were captured using the CS 3600 (Carestream Dental) intraoral scanner (Figs. 2 & 3). In addition to illustrating the current condition to the patient during her case presentation, the digital images were used for further analysis of tooth position, tooth size and arch form for the proposed treatment of full mouth edentulation, leveling and grafting. Immediate dentures for both arches would be delivered on the day of surgery; however, in the lower archfour dental implants would be placed to support an overdenture.

    Fig. 3Fig. 4

    Fig. 3                                                                                Fig. 4

    Financing options using a third-party payment option (Lending Club) were discussed with the patient. This discussion was a very important part of facilitating acceptance of her care since it made the cost of treatment more feasible.

    Starting in the maxillary arch, the teeth were extracted using the Physics Forceps (GoldenDent). The Physics Forceps act simply like a Class I lever, where only one force is applied with the beak on the lingual aspect of the tooth. Once the beak is placed at the lingual cervical portion, the soft bumper is placed on the buccal alveolar ridge at the approximate location of the muco-gingival junction to balance the beak. The beak grasps the tooth, while the bumper is the fulcrum to provide leverage and stability for the beak. Extraction is accomplished with wrist movement rotation in a buccal direction, which is usually accomplished within 30 to 60 seconds depending on the tooth morphology.

    Continue to page two to read more...

    Ara Nazarian DDS, DICOI
    Dr. Nazarian maintains a private practice in Troy, Michigan, with an emphasis on comprehensive and restorative care. He is a diplomate ...

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