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Transcript of D3 Perio
CC: "I want to replace my missing #5"
Med Hx: ASA I
Meds: St. John's Wort and Omega 3
Fx, TE #5
Expressed interest in orthodontic tx to close diastema in maxillary anterior
Several occlusal composite restorations
Pt reports dentist in Hiawatha providing the rest of his care
Social Hx: former football player from Atkins, IA Multiple composite restorations appear to have recurrent decay
#4M composite restoration - "catches with explorer but not soft"**
Pt informed about implant next to questionable restoration, ortho tx
7mm BL, 8mm MD
Interocclusal space 4mm (deficient)
Rec several mm vertical osteoplasty No potential maxillary sinus involvement
Socket site #5 still visible
Adequate bone density and dimension Treatment Plan Single Tooth Implant Placement February 1, 2013 Edentulous site #5 Etiology and Risk Factors RCT w/o definitive restoration
Extraction Other: OH? Prognosis Short term: Good!
Long term: Good! (Provided good integration, home care and regular maintenance) Systemic Phase: none
Acute/Emergency Phase: none
Disease Control Phase: Prophy, OHI, Replace failing restorations, Restore caries
Rehabilitation Phase: STI #5
Maintenance Phase: Recall prn Therapy STI #5 w/ IV sedation
Goals: Replace missing tooth structure, Restore function, Improve esthetics
Restorative alternatives: FPD #4-6, URPD, no replacement Evaluation of Outcomes EBD: Appraise EBD: Apply Esthetic-conscious patient is pushy and doesn't want to wait 6 months for a junior dental student to make them a crown. Is there a difference in success between the different implant loading schedules?
Tommaso Grandi, Giovanna Garuti, Paolo Guazzi, Luciano Tarabini, Andrea Forabosco (2012) Survival and Success Rates of Immediately and Early Loaded Implants: 12-Month Results From a Multicentric Randomized Clinical Study. Journal of Oral Implantology: June 2012, Vol. 38, No. 3, pp. 239-249.
No - Main results: Early loading (2 months) and immediate loading implants had similar peri-implant bone loss at 2, 6 and 12 month intervals (approximately 0.4mm). There was not a statistically significant difference between the groups.
Critical Summary of Immediately Loaded Single Tooth Implant Crowns. Atieh MA, Atieh AH, Payne AGT, Duncan WJ. International Journal of Prosthodontics. 2009;22(4):378-87
Yes - Main results: "Better outcomes are achieved with conventional loading of single implants with crowns, as opposed to immediately loaded implants, which carry a higher risk of failure (Atieh, 2009)."
Inconsistency in definitions - some studies indicate early loading as up to 2 months, some say 3. "Immediate loading" in many studies should actually be considered "immediate restoration" because there are no centric or eccentric contacts. After sulcular incisions Preop Flaps reflected
Bone exposed Osteotomy Healing Abutment Placed Sutures placed (5-0 Vicryl) Surgery 16 mg Midazolam
100 mcg Fentanyl
1.8 cc 0.5% Bupivicaine w/ Epi
3.4 cc 4% Articaine w/ Epi Perio implant checks - implant osseointegrated, no mobility. Restored with PFM Crown in Family Dentistry Pt is pleased and CC addressed! Depth Check Implant Placed Because there is some evidence to suggest that conventional loading is more successful, that would be my recommendation to the patient.
For future tx:
I recommend caries control and a prophy for this patient. It will be critical for long term success that he seek regular dental care and have excellent oral hygiene. Thank you!