Dentaltown May 2017 - 28

Fig. 1

Continued from p. 26

Fig. 2

Fig. 3

Medical history and examination

Treatment plan

The subject was an invalid 76-year-old
who is confined to bed all day, unable to
walk because of chronic pain in her legs
and joints, and is mobile only when using
a wheelchair. The patient wore a cardiac life
vest because of a history of cardiac arrest,
and has general anxiety and depression as
well as dental anxiety. She has some clarity
of thought during the day but her dementia
worsens at night.
Medications include: Plavix, 75 milligrams once a day; lorazepam, 1mg once
a day; oxycodone, 1mg once a day; aspirin,
81mg once a day; hydrocortisone, 10mg
twice a day; Zyprexa, 10mg once a day;
acetaminophen, 500mg three times a day;
Effexor, 75mg four to six times a day; and
doxepin, 50mg twice a day.
Dental findings: Poor maxillary dentition, remaining teeth not restorable; full-arch
extractions indicated. Resorbed mandible,
ill-fitting existing denture.
The patient's husband told me that she
no longer wanted to eat solid food because
it had become too difficult to eat with a
denture that didn't fit and upper teeth that
were brittle and painful, so he blended her
foods and she basically drank her nutrition.
Her husband also had trouble eating
for years before undergoing full-mouth
mini-dental implant treatment, and he
suggested that his wife could receive the
same style of implant treatment. Such
treatment had been discussed for a year, but
a "cosmetic emergency" occurred when the
patient broke a front tooth.

Because of the patient's health and the
effort required for her to come into the office,
each visit needed to be very efficient, with
as much work completed as possible. This
case was completed in four visits; medical
clearances from her primary care physician
and cardiac specialist were obtained before
we began.
Visit #1: We gathered all diagnostic
data-full-mouth radiographs (Fig. 1), preop
photos (Fig. 2), CBCT scan (Fig. 3) and study
model impressions. The patient was mildly
sedated-30 milligrams of hydroxyzine
slurry swallowed and 0.125mg triazolam
crushed sublingually-and monitored with
pulse oximeter throughout the treatment
phase of the appointment.
A fter using Carbocaine 3% nonepinephrine local anesthetic to anesthetize
the patient, I performed an atraumatic
extraction for tooth #7, placed a 2.5-by15mm implant (Fig. 4) and fabricated
a temporary crown. I then switched my
attention to the lower arch.
The patient's mandible was so resorbed
that her lower denture did not fit in any usable
way. I placed four mini-dental implants (2 by
10mm) with O-ball attachments (Fig. 4).
I then cut away the posterior segments
of the existing denture, leaving only the
anterior six teeth to be used as a temporary,
and processed the housings for the four
mandibular implants into the anterior
segment of the denture, using a self-cured
denture base resin.
Continued on p. 30

Fig. 4

28

MAY 2017 // dentaltown.com


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