Dentaltown August 2021 - 65

by Dr. LeRoy Horton
Dr. LeRoy Horton completed his bachelor's degree in
biology from Pacifi c Lutheran University in Washington
state in 2003, then earned his DDS degree from
the University of Washington School of Dentistry in
2007. Having always been fascinated with dental
implants, Horton pursued advanced training over the
years, attaining fellowships and completing master's
courses. Eventually he earned his board certifi cation
as a diplomate of the International Congress of Oral
Implantology. He owns two practices in the greater
Seattle area and serves our profession as a nationally recognized AGD instructor.
Case study
The patient presented with an edentulous
#12 and was seeking implant therapy
options.
I typically have the luxury of having
my patients' comprehensive dental health
information; with referral cases, however,
that information often is absent. I try to get
the patient's history during a consultation
in which I do a full perio charting and
note any concerning needs, such as active
or pending infections, occlusal challenges
and gross decay.
As a rule of thumb, I place implants only
in patients who show a fair to good degree
of overall oral health and stability. If there
are any red fl ags, I initiate an informative
conversation with the patient and the
referring doctor about options, priorities
and timelines. This may sometimes lead to
rejecting or postponing implant therapy, but
always in the best interest of the patient.
I have developed a preliminary checklist
to guide my decision-making and standardize
my case selection, which helps ensure that
I stay within my parameters for treatment
safety and success. Checklists have been
associated worldwide with improved outcomes
for patients, and having a systematic
approach and standardized plan has shown
to decrease communication failures and
complications.2
For this particular patient, the list was
as follows:
* Medical history/medications:
No contraindicative conditions
or medications.
* Oral health: Missing teeth #2, 12,
14, 18, 19 and 31; generally healthy
gingiva and apparently fair oral
hygiene; no history of periodontal
disease; no pending emergencies or
infections; minor restorative needs
only.
* General occlusion: Class I molars
and canines, adequate restorative
space, stable bite.
* Anterior occlusion: Mild wear,
1 mm overjet, 2 mm overbite.
* Biotype: Medium to thick.
* Aesthetic demand: Mild to moderate.
* Goal: To augment the defi cient
bone for implant placement and
subsequent restoration.
The panoramic image (Fig. 1) shows
stable occlusion from the right molars to
left second premolars. The patient was
interested in implants for #14, #18 and #19
in the future, but were not a priority for
him at this time.
Fig. 1
Fig. 1: Panoramic image showing the general
oral health and the patient's dental state.
Fig. 1
Fig. 2a
Fig. 2b
Fig. 2a: CBCT cross-sectional image
of the edentulous site showing the
measurements of existing bone.
Fig. 2a
Fig. 2b: Intraoral image showing the
visual defect of bone on the buccal.
Fig. 2b
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Dentaltown August 2021

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