IMMEDIATE TOTAL UPPER AND LOWER LOADING IN PATIENT WITH SEVERE PERIODONTITIS

Carico immediato totale superiore e inferiore in paziente con parodontite grave

GIUSEPPE BIANCO

MARCO GERONI

Periodontal disease, or periodontitis, is a very frequent pathology, especially after the age of 50, which occurs more in smokers, genetically predisposed and / or with poor oral hygiene, and which can involve few dental elements or even the arches in their entirety.

Gianni comes to my observation for a periodontal problem. He had consulted more than one specialist over time, without ever being able to solve the problem, coming to suffer from it in a chronic way, a condition that results in the loss of the dental elements involved with functional and emotional problems.

Fig. 1 Gianni’s hinted smile.

Fig. 2 The situation in the first visit. A completely incongruous rehabilitation, both from a technical and aesthetic point of view.

The therapies he had received probably hadn’t been effective and the prostheses he wore were certainly not a good job.

The upper arch had a long splint, made brutally with wire and liquid resin, which has been damaged over the years, fracturing, and undergoing continuous repairs. A splint was also present on the anterior teeth of the lower arch, done by a colleague to improve their stability, compromised by periodontal disease; this type of treatment was not in accordance with the patient’s needs.

Fig. 3 A view of the upper arch, from which the long splint can be clearly seen.

Fig. 4 The lower arch.

Fig. 5 The orthopanoramic shows the signs of chronic generalized periodontitis, namely the loss of attachment, bone resorption and recessions. Important radio-transparencies are also clearly visible in correspondence with some dental apexes. There is little or no support for the teeth.

By analyzing the radiographic, orthopanoramic, full intraoral and 3D CT exams performed at our center, we verified the severity of his pathology, unfortunately very aggressive. The residual periodontal attachment, that is, the set of structures that keep the tooth tied to the bone, was minimal, almost zero in some areas. The furcations of the multi-rooted elements were all exposed and this denotes a degree 3, which in some cases constitutes a point of no return.

We therefore agreed with Gianni a concrete plan that would solve his problem, proposing a fixed implant-supported rehabilitation on Toronto Bridge type implants with immediate load.

In the two weeks prior to the surgery, we subjected Gianni to a thorough non-surgical instruction, as a prophylaxis to reduce the bacterial load present as much as possible.

On the day of the surgery, the dental elements, both as regards the lower arch and the upper arch, now compromised, were extracted. We then regularized and cleaned the bone structures by means of the Piezosurgery ® with dedicated piezo-surgical inserts. The insertion of the Biomet 3i implants with external connection, six above and five below, was carried out immediately and in a single session, thanks to local anesthesia and sedation, which allow us to work without making the patient feel anything.

Fig. 6 The orthopanoramic performed the day after the surgery, just after having delivered the prosthesis.

The dental technician work of my friend Marco Geroni, with whom I have been collaborating for years, took place in 24 hours, allowing us to deliver the prostheses the next day.

For Gianni’s case, we chose a resin prosthesis with a titanium core that solidifies the implant abutments and therefore the implants to the laser. It was important to obtain maximum stability and a certain rigidity of the structure: this allows to minimize and almost cancel the micro-movements that the implants can undergo in the first months; these constitute one of the risk factors for the lack of integration and stabilization of the implants within the bone, which takes a relatively long time (from 2 to 6 months) to organize its structure around the implant threads.

Fig. 7 The upper prosthesis and the lower prosthesis (Fig. 8) mounted on the laboratory models, before being delivered. The holes for the fixing screws to the implants are clearly visible.