Gerardo comes to our attention suffering from chronic generalized periodontal disease, some missing dental elements, and an important atrophy for both the maxillary bone and the mandible.
The habit of smoking, combined with inadequate home hygiene, led to an evident accumulation of plaque an tartar, with consequent gingival inflammation, recessions and bone loss.
The orthopanoramic and 3D CT, performed at out center during the first visit, highlighted the state of periodontal disease and the severity of bone resorption, especially regarding the upper jawbone.
Fig. 1 The situation of Gerardo in the first visit. Plaque and tartar cause inflammation and bleeding. Unfortunately, periodontal disease is chronic and worsening.
Fig. 2 The orthopanoramic shows the severe bone resorption and the consequent loss of support for all elements in the arch, both upper and lower.
After a careful first visit and after listening to Gerardo’s needs, and also expectations, in agreement with the patient, it was decided to proceed with a total upper and lower implant-prosthetic rehabilitation of the Toronto Bridge type with immediate load (→ to know more).
To prepare the patient for the surgical phase, we proceed with a non-surgical periodontal therapy (→ to know more) through the recovery of hygiene thanks to a deep professional cleaning and maintenance education, together with training for abandonment the habit of smoking, which is a habit incompatible with the survival of an implant-type rehabilitation. Although all teeth must be extracted, it is essential that they are thoroughly cleaned before surgery, to prevent the bacteria present in the tartar from giving rise to systemic pathologies by entering the bloodstream.
The surgery, performed under conscious sedation and local anesthesia, therefore without any kind of pain, saw the extraction of the residual dental elements, completely compromised by periodontal disease, and the immediate insertion of six implants for the upper arch and six implants for the lower arch.
Thanks to the technology and software for the virtual positioning of the implants, we are able to position the prosthetically guided implants, also trying to place them where we have a better quality and quantity of bone.
After about two hours of surgery, the prosthetic phase begins with the taking of the plaster impression, the recording of the vertical height, the taking of the facial bow and the assembly of the six anterior teeth (from canine to canine) to ensure that you have a pleasant ecstatic and a congruous and centered smile line.
After about 24/48 hours of intense work by my dental technician friend Marco Geroni, the delivery of the prostheses and the consequent “immediate load” took place, that is the possibility for the patient to functionalize the prostheses and resume eating… and smiling… immediately.
Fig. 3 On the day of delivery, the prostheses are screwed onto the implant posts and checked in aesthetic, occlusal and functional analysis.
Fig. 4 The post-operative control orthopanoramic. The implants are well placed. You can see the post-extraction alveoli that will undergo healing and new bone formation
The only attention that the patient must have is a very soft diet for the first 3 months, scrupulous personal hygiene and, possibly, refraining from smoking.
Fig. 5 The before and after of Gerardo. He regained his smile.
PROF. GIUSEPPE BIANCO
I am a clinician who has been working 10 hours a day for 20 years, since 1999 I have placed about 11,000 implants.
WHERE TO FIND ME
Via dell’umanesimo 308
00144 Rome (RM)
(0039) 06 591 0674