Managing Patient Expectations with Implant Treatment

Authors

Daniel B. Kamran, University of the Pacific, Arthur A. Dugoni School of DentistryFollow
Mark Booth DDS, University of the Pacific, Arthur A. Dugoni School of DentistryFollow
Eduardo Gonzalez DDS, University of the Pacific, Arthur A. Dugoni School of DentistryFollow
Ed Shaw DDS, University of the Pacific, Arthur A. Dugoni School of DentistryFollow

Lead Author Affiliation

DDS 2018, University of the Pacific, Arthur A. Dugoni School of Dentistry

Introduction/Context/Diagnosis

This patient came to University of the Pacific, Arthur A. Dugoni School of Dentistry to get implants and implant crowns to improve his smile, replacing his upper partial denture. Different approaches were made by the faculty to arrive at best outcomes, which took four years for the patient to receive the treatment he wanted. This abstract will further detail how the treatment was conducted and the results afterwards.

Methods/Treatment Plan

1. CBCT taken in 11/2016, placed digital implants with the use of Anatomage. Collect information regarding height, depth, and width of maxillary arch.

2. Review patient’s desired final result for prosthesis and esthetics, determining what the correct angulation of implants will be. Finalized treatment plan: 3 implants with a 6 unit bridge from # 5-10.

3. Order surgical guide, implant components, and place implants with surgical guide following a 2 Step Implant process.

4. After 3-6 months of healing, checked osseointegration as well as raised a flap to place healing abutments and to conserve gingival tissue.

5. Implant final impression was taken after determining that implant copings were fully seated with radiographic evidence. Used an open tray for impression as well as splinted copings together.

6. Determined final prosthesis material type (PFM), as well as color of final prosthesis.

7. Checked passivity of metal framework, added procelain to framework, and delivered final prosthesis following UoP CIBOE protocol.

8. 1 month recall to determine patient acceptance.

Results/Outcome

1. CBCT and patient’s decision helped to determine that the anterior maxillary arch had the necessary characteristics that would support the long term implants. Bone Density - Appropriate, Ridge Width - >3mm, and Arch Height - >13mm

2. Implants were placed with surgical guide, #8 and #9 were placed at similar angulations, whereas #6 was off center comparatively. May create issues with final prosthesis.

3. Raised flap, placed healing abutments, and sutured gingiva resulting in a very nice esthetic result without compromising the gingiva.

4. The final prosthesis was well received and pt was very happy with the result.

Significance/Conclusions

Some of the issues noted earlier were the different approaches between dentists on how to treat the patient. Dr. Booth was able to help establish the best method for the patient to receive his implants. He also was able to fully communicate with the patient as to why his case was quiet complex and how getting a great final result would be difficult for anyone. In the end, the final decision was to have the case conducted by a student with close supervision by Dr. Shaw and Dr. Gonzalez. Dr. Gonzalez helped with the surgical portion of the implant process by placing the implants and conducting the post surgery exposure of the implants. In addition, Dr. Shaw helped with the final prosthesis portion. The combined efforts made the final result beautiful, and made the patient extremely happy. Overall, I believe the biggest lessons we learned with this case were managing patient expectations and the collaborative teamwork between specialists to make the desired product.

Location

2nd floor clinic and reception waiting areas

Format

Presentation