Australasian Dentist Implant Dentistry Today No 15

Implant Dentistry Today 16 I t is fundamental that oral health professionals are able to identify patients with compromising conditions, systemic diseases and disabilities that have an impact on, and can be impacted by, oral health care. To this end, an accurate medical history is a vital part of the patient’s assessment and increases the dentist’s awareness of diseases and medication that could interfere with the dental treatment. ntrodu tion The following case report describes the interdisciplinary treatment of a medically compromised patient with a less invasive approach, avoiding a sinus lift procedure and using two short Straumann® BLX implants to restore a posterior edentulous area. The Straumann® BLX implant is made of Roxolid® material and coated by a SLactive® surface. Roxolid® is a metal alloy composed of ~15 % zirconium and ~85 % titanium which is stronger than pure titanium and has excellent osseointegration and biocompatibility properties1-3. Moreover, the SLActive® surface has shown an extensive healing potential and recent studies have reported an outstanding clinical performance even in very challenging treatment protocols and patients with compromised health4-5. In this case, these features played an important role to successfully treat this compromised patient and fulfil all his expectations in a very predictable way. nitia situation A 72-year-old male patient came to our dental practice with the chief complaint of poor masticator function due to the loss of posterior teeth in the upper jaw. He referred that was looking for a fixed solution to replace the missing teeth in order to be able to chew properly. His medical history revealed hypercholesterolemia and atria fibrillation, which were under control with Atorvastatin (statin) and Edoxaban (anticoagulant). Moreover, he also referred a history of chronic periodontitis, which was the reason for his missing teeth. The extraoral examination showed a symmetrical and proportional face. The analysis of the smile demonstrated a midline sagittal plane coincident with the medium line of the smile, but with a lower midline 1mm deviated to the left side of the patient. Moreover, he presented a low smile line and the approximately exposure of the upper incisors and canines were 70% and 55% respectively (Figs. 1-3). The intraoral evaluation revealed the missing posterior teeth on the left maxilla with a good amount of keratinized gingiva in the edentulous area (Figs. 4, 5). Oral hygiene was evaluated as good. The radiographic evaluation was based on a panoramic radiograph and CBCT. The second quadrant displayed images compatible with absence of teeth #25, #26, #27 & #28, as well as limited vertical bone availability in this posterior maxilla area (Figs. 6, 7). The CBCT scan used radiopaque guides to facilitate the evaluation of the possible location of implants placed in positions #25, #26 and #27. Images compatible with thin cortical bone and very trabecular bone in this edentulous area were shown, as was the difficulty of placing a standard implant length due to the limited vertical bone availability (Fig. 7). reatment anning Since his systemic condition required a team approach, before defining the treatment plan we asked for a consultation with his cardiologist. The specialist advised discontinuation of the medication one day before any surgical therapy and the avoidance of very invasive and prolonged procedures that could lead to extensive bleeding. Following the systemic, clinical, and radiographic assessments, we were left with three possible treatment options: 1. Open sinus lift with placement of two implants (immediate/delayed) traumann®6mmBLX implants supporting a screw retainedmultiple-unit restoration in amedically compromised patient Clinical case by r lfonso Caiazzo , Italy Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6