Dentaltown May 2017 - 30

Fig. 5

Fig. 6

Continued from p. 28
The patient left with a removable anterior
denture segment. "This is the first time in
years I have seen her with lower teeth," her
husband said. They were both ecstatic.
PVS impressions and bite registration were
made to have a full-arch resin roundhouse
mandibular appliance made, to be made by
the Shatkin First dental lab. I asked the lab
to provide room for additional implants that
would be placed at the delivery visit (Fig. 5).
During the two weeks or so it took for
the lab to fabricate the lower appliance, the
patient's husband called to say that the lower
temporary appliance had come loose. I visited
the patient's home to cement the temporary
appliance for stability. The patient reported
no other complications or problems.
Visit #2: The patient arrived excited
to receive her lower teeth. The temporary
appliance offered improved aesthetics, but the
patient still was not able to eat as she desired.
After anesthetizing and administering
sedation medications to her, as described
for the first visit, I removed the temporary
denture and placed three additional Shatkin
First mini-dental implants, 2 by 10mm. This
gave the patient a total of seven implants to
stabilize the lower appliance. I then cemented
the resin roundhouse in place (Fig. 5).
The next step was to take impressions
to prepare for the third visit. An upper PVS
impression was made for the lab to fabricate
an upper resin roundhouse restoration for

Fig. 7

30

MAY 2017 // dentaltown.com

the maxilla. (I asked the lab to remove the
remaining maxillary teeth from the model
when fabricating the upper appliance.)
The lower opposing impression and bite
registration was also taken. The extractions
and implant placement would be completed
at the third visit.
Visit #3: Before the upper restoration
was received back from the lab, another
"cosmetic emergency" occurred. The patient
fractured tooth #9, and she returned to
the office to have it taken care of. I mildly
sedated her with 30mg hydroxyzine and
0.125mg triazolam. Using 3% Carbocaine
with no epinephrine, I extracted tooth #9,
and placed a Shatkin First Intralock implant
(2.5 by 13mm). I then took an impression
and new bite registration to send to the lab to
provide the exact location of the new implant.
Visit #4: The final treatment visit for this
patient was for the extraction of remaining
maxillary teeth, the immediate placement
of implants and to retrofit the upper resin
roundhouse appliance that accommodated
the immediately placed implants. The
procedure was performed under the same
sedation protocol followed at previous visits.
After removing the remaining maxillary
teeth, six additional 2.5-by-13mm implants
were placed to support the full arch restoration (Figs. 6 and 7). Two implants had
been placed previously when the patient
fractured teeth #7 and 9. The resin appliance



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