Dentaltown September 2022 - 51

Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
The patient had seen the same dentist for
38 years, with several restorative treatments
to fix problematic areas as needed (Fig. 2).
Nothing had been done comprehensively,
however, and as time went on, the patient
needed to have a definitive treatment plan.
His options included a full maxillary denture,
an implant-supported maxillary overdenture
or a maxillary hybrid implant prosthesis,
which the patient chose.
Procedure
Blood was drawn in the left antecubital
fossa to fill four 3-cc vials, which were
centrifuged for 12 minutes at 2,700 rpm to
gain plasma-rich fibrin that would be used
as a membrane over the implant/graft sites.
The vena puncture was made in the right
dorsum of the hand. Vital baselines were
established. Medications included 5 mg of
Nubain, 10 mg of midazolam, 20 mcg of
dexmedetomidine, 1 g of cefazolin and 8 mg
of dexamethasone for the entire procedure.
The patient stayed in Level III sedation until
the procedure was completed.
Teeth #4, 5, 6, 9, 11, 15 and 18 were
extracted, and a flap reflection was created
in the area from #4 to #12 by using a
10,600-nanometer CO2
laser with 0.5 mm
spot size. Elevators were used to reflect tissue.
52 SEPTEMBER 2022 // dentaltown.com
A surgical handpiece was used on the
alveolar crest to create a flat surface on which
to place implants. (Because #10 already
had an implant placed from a previous
treatment, new implants were planned only
for sites #5, 6, 7, 9 and 11.) Periotomes were
used around teeth to loosen ligaments and
Physics Forceps (Golden Dental) were used
to aid in elevation.
Implants were placed using Densah
drills (Versah, Fig. 3) with diameters of
2 millimeters, 2.3 mm, 2.5 mm, 3 mm and
3.5 mm, and started 4 at mm. Implants
(Zimmer TSVT, Zimmer Biomet Dental)
were all 4.1 mm diameter, while lengths
were either 10 mm (#5 and #7) or 13 mm
(#6, #9 and #11).
Before seating the implants, an erbium
laser (Biolase) was used for about 40 seconds
(Fig. 4) to increase fibroblast formation
and detoxification.1
Then, Bio-Oss bone
(Geistlich Pharma AG) was placed in gap
spaces (Fig. 5) and soaked with plasma
from the PRF membranes,2
followed by the
membranes themselves (Fig. 6) being placed
over this and closed with 3.0 polytetrafluoroethylene
sutures. Finally, the laser was
used again (Fig. 7) to cover the entire site
and 1 centimeter beyond. This also aided
the increase of soft tissue healing.3
Photobiomodulation (Thor, Chesham)
was used-with 12 joules of energy at
sites of implant placement and 6 j at the
submandibular and subclavicular lymph
nodes-to increase natural endorphins for
pain management and decrease swelling
by stimulating lymph system in the head
and neck region.4
Then, the provisional
denture was delivered and the vena puncture
was removed.
Postoperative steps
At the first postoperative appointment,
one day after surgery, the patient reported
minimal discomfort, but we adjusted three
sore spots and placed a soft liner to allow
better retention of the provisional denture.
One week after surgery, the sutures
were removed and we again adjusted sore
spots in the maxillary provisional denture.
PBM was done again to surgical sites, using
6 j of energy to promote healing5
and 6 j to
aid the lymph nodes to prevent swelling.6
The patient was seen over a few more
visits to adjust sore spots in the provisional
appliance and to change soft liner to aid in
retention of it.
After three months, implants were
uncovered using a 10,600 nm CO2
(Denta 2, Great Plains Technology), with
laser
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Dentaltown September 2022

Table of Contents for the Digital Edition of Dentaltown September 2022

Dentaltown September 2022 - 1
Dentaltown September 2022 - Intro
Dentaltown September 2022 - Cover1
Dentaltown September 2022 - Cover2
Dentaltown September 2022 - 1
Dentaltown September 2022 - 2
Dentaltown September 2022 - 3
Dentaltown September 2022 - 4
Dentaltown September 2022 - 5
Dentaltown September 2022 - 6
Dentaltown September 2022 - 7
Dentaltown September 2022 - 8
Dentaltown September 2022 - 9
Dentaltown September 2022 - 10
Dentaltown September 2022 - 11
Dentaltown September 2022 - 12
Dentaltown September 2022 - 13
Dentaltown September 2022 - 14
Dentaltown September 2022 - 15
Dentaltown September 2022 - 16
Dentaltown September 2022 - 17
Dentaltown September 2022 - 18
Dentaltown September 2022 - 19
Dentaltown September 2022 - 20
Dentaltown September 2022 - 21
Dentaltown September 2022 - 22
Dentaltown September 2022 - 23
Dentaltown September 2022 - 24
Dentaltown September 2022 - 25
Dentaltown September 2022 - 26
Dentaltown September 2022 - 27
Dentaltown September 2022 - 28
Dentaltown September 2022 - 29
Dentaltown September 2022 - 30
Dentaltown September 2022 - 31
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Dentaltown September 2022 - 33
Dentaltown September 2022 - 34
Dentaltown September 2022 - 35
Dentaltown September 2022 - 36
Dentaltown September 2022 - 37
Dentaltown September 2022 - 38
Dentaltown September 2022 - 39
Dentaltown September 2022 - 40
Dentaltown September 2022 - 41
Dentaltown September 2022 - 42
Dentaltown September 2022 - 43
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Dentaltown September 2022 - 47
Dentaltown September 2022 - 48
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Dentaltown September 2022 - 50
Dentaltown September 2022 - 51
Dentaltown September 2022 - 52
Dentaltown September 2022 - 53
Dentaltown September 2022 - 54
Dentaltown September 2022 - 55
Dentaltown September 2022 - 56
Dentaltown September 2022 - 57
Dentaltown September 2022 - 58
Dentaltown September 2022 - 59
Dentaltown September 2022 - 60
Dentaltown September 2022 - 61
Dentaltown September 2022 - 62
Dentaltown September 2022 - 63
Dentaltown September 2022 - Cover3
Dentaltown September 2022 - Cover4
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