implants - international magazine of oral implantology International Edition

case report I I 17implants1_2014 _Clinical findings The patient complains about a purulent inflam- mationintheleftupperquadrantandgingivalbleed- ing (Fig. 1). Metal crown margins in the aesthetic zone on tooth 21 are visible and cause a significant dissatisfaction for the patient. The patient expresses a strong interest in keeping this tooth. Generally, she suffers from macular degeneration with vision loss of 20 and 80 per cent. The periodontal examination shows increased probing depths of up to 12 mm in the mandible and upto13mminthemaxilla,withaBOPof36percent. Verticalbonelossandapicalradiolucencyareevident fromtheOPTGandtheintraoraldentalX-rayimages (Fig. 2). The teeth 17, 25, 27 and 38 are not worth retain- ing and prognoses of the teeth 16, 15, 21, 24 and 46 are questionable. _How would you proceed? A chronic aggressive periodontitis is diagnosed. The detailed diagnosis of the case can be found on- line at Dental Campus. At the e-learning platform, you can also create your own diagnosis for this pa- tient with a few mouse clicks, define the prognosis for each tooth and plan the treatment using the dig- ital dental chart. Then, you may compare your plan- ning with the planning of other users and with the actual therapy option chosen by the treating practi- tioner. Optionally, you can discuss the treatment op- tions in the forum. _Therapy a)Periodontalpretreatmentwithtoothextraction Which teeth should be extracted before the periodontal treatment? Teeth 17, 16, 25, 27 and 38 are to be extracted. During periodontal therapy, the patient is given a partial denture anchored on teeth 15 and 24. For teeth 15 and 46, an open procedure is chosen. Here we observe that tooth 15 is also not worth pre- serving, although the tooth during the cold test re- sponded as vital (Fig. 3). At tooth 46, the probing depth has decreased but still amounts to 6 mm dis- tolingually and 7 mm distobuccally. b)Surgicalphase After periodontal therapy, the sinus floor is bilat- erally augmented (Fig. 4a). In order to improve the bone volume, a horizontal ridge augmentation in quadrant2isalsoperformed(Figs.4b-c).Implantsare placed in regions 17, 16, 25 and 27. c)Prostheticrestoration Selected stages of the prosthetic restoration are showninFigures5–8.Theentiredetailedprocedureis illustrated online with numerous images. Tooth 21 is re-crowned on the original post and abutment. Teeth 46 and 47 each receive single crowns. Teeth 24, 36, 37 and 45 get new composite fillings. Would you have chosen the same approach, or wouldyourecommendadifferenttherapyoptionfor thepatient?Insteadoflarge-scalefillingsonteeth24, Fig. 3_The open periodontal therapy shows that tooth 15 is not worth preserving. The tooth is extracted. Figs. 4a–c_Bilateral sinus floor elevation, implantation and horizontal ridge augmentation. Only Quadrant 2 is shown. Fig. 5_Preparation of tooth 46 and 47. Figs. 6a & b_Clinical situation at impression-taking. Fig. 4c Fig. 6aFig. 5 Fig. 3 Fig. 4bFig. 4a