HPI: Male in his 70s presenting with loose teeth in the mandible and currently wearing a removable partial denture. He has also been in a maxillary complete denture for decades. He desired a fixed prosthesis.
Pertinent PMH: Hypertension, Cigar smoker, 2-4 alcoholic beverages per day
Pertinent Exam: Edentulous maxilla with stained complete denture with copious amounts of denture adhesive, partially edentulous mandible with poor oral hygiene in remaining dentition, mobile teeth, a partial denture with calculus, class 1 occlusion
Panorex and CBCT: Severe periodontitis in remaining mandibular dentition with periapical disease, severe atrophy of maxilla in zones 1-3, pneumatized maxillary sinuses with L>R
Assessment: Maxillary atrophy in zones 1-3, pneumatized maxillary sinuses, nonrestorable remaining mandibular dentition due to severe periodontal disease
Plan: The patient at first only wanted to concentrate on the mandibular arch. 5 implants were placed in the mandible under IV sedation and immediate conversion to a mandibular fixed hybrid provisional prosthesis was performed in one appointment
The patient was very pleased with the results and wished to also have a fixed prosthesis in his maxilla as well. Due to the sinus anatomy on the left and the severe atrophy of his maxilla from the long-term edentulism and denture wearing, a combination of subnasal, zygomatic, and pterygoid implants were planned under IV anesthesia. Another immediate chairside conversion was performed to place the patient in a temporary fixed hybrid prosthesis in the maxilla.
The patient was very pleased with the results and wished to also have a fixed prosthesis in his maxilla as well. Due to the sinus anatomy on the left and the severe atrophy of his maxilla from the long-term edentulism and denture wearing, a combination of subnasal, zygomatic, and pterygoid implants were planned under IV anesthesia. Another immediate chairside conversion was performed to place the patient in a temporary fixed hybrid prosthesis in the maxilla.
