Chronic advanced periodontitis can result in severe loss of periodontium, which is often associated with systemic conditions. Among these conditions, heavy smoking is linked to the degree of severity of periodontal disease .Restoring the oral function and esthetics in these patients becomes a challenge and requires major bone grafting or artificial gingival tissue. Bone grafting is usually required before placing dental implants .However, horizontal bone augmentation procedures are often difficult and offer an unpredictable result .Furthermore, in patients with chronic periodontitis with multiple endo-periodontal lesions, the remaining infection often prevents simultaneous tooth extractions and bone grafting or immediate placement of implants.
Here we present a case report of a patient, suffering from severe alveolar bone loss, who had undergone a full mouth reconstruction with Full mouth dental implants. We also presented an option of extractions with minimal bone grafting and early placement of implants after tooth extractions. We had restored the oral function and esthetics of these patients with fixed screw-retained implant supported prostheses.
Preoperative Information and Treatment Planning
A 49-year-old Asian male presented to the University of North Carolina Dental Faculty Practice with the chief complaint of “All my teeth are loosening and I need fixed bridges.” The Patient reported that he was in good health and had no known allergy. However, he smoked about one to two packs of cigarettes a day for over thirty years. Clinically, almost all of his remaining teeth appeared to have second to third degree mobility (Fig. 1a,b,c,d preoperative photographs). Most of his maxillary anterior teeth appeared to have less than 10 percent remaining alveolar bone support. These teeth were loosening and appeared to suffer from traumatic occlusion secondary from the condition of advanced loss of periodontal support and flare out of their original positions. Most of his molars also had significant bone loss and through-and-through furcation involvement. Many teeth also exhibited communication between periodontal lesions and apical lesions (Fig. 2a,b -preoperative CTscans). Based on the Prosthodontic Diagnostic Index (PDI), the American College of Prosthodontists’ Classification System for the Dentate Patients, this patient was a PDI class IV. A treatment plan was constructed including removal of all his remaining teeth, immediate complete dentures, implant placement, and fixed implant-supported prostheses.
Surgical Procedures and Interim Prostheses
To minimize the number of surgeries and the length of healing time, we decided to perform two separate surgeries including removal of his natural teeth; and placement of dental implants. The patient was advised that heavy smoking can contribute to poor tissue healing and may reduce the success rate of implants. As a result, he had stopped smoking the day before his first surgery.
In the first surgery, we removed all remaining natural teeth and delivered immediate dentures. Atraumatic extractions followed by socket hemostasis with gelatin sponge (Gelfoam, Pfizer) and sutures were performed. To reduce the occlusal force to the healing sockets, the immediate complete dentures were delivered with tissue conditioner (Coe Comfort, GC) (Fig. 3a3a-Immediate dentures).