extraction, immediate implant placement, veneer provisional
TRANSCRIPT
Loma Lin da Un iversity
Patient Presentation Seminar
PATIENT PRESENTATION
Prepared by Dr. ChauLong Nguyen, DDS,
MAGD
November 12, 2015
Loma Lin da Un iversity
Patient Presentation Seminar
Healed Site Immediate Loading
Veneer Provisional on Abutment
D r. auLong NguyenDDS, MAGD
Loma Lin da Un iversity
Patient Presentation Seminar
My office- reception desk to the left
Loma Lin da Un iversity
Patient Presentation Seminar
Loma Lin da Un iversity
Patient Presentation Seminar
Loma Lin da Un iversity
Patient Presentation Seminar
Loma Lin da Un iversity
Patient Presentation Seminar
Reception Area & Hall Way to Treating Rooms
We have 16 windows around the office.
Loma Lin da Un iversity
Patient Presentation Seminar
Loma Lin da Un iversity
Patient Presentation Seminar
Loma Lin da Un iversity
Patient Presentation Seminar
Treating rooms
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Patient Presentation Seminar
Why most Africans have white teeth?
In November 2013, I went to Africa for safari gaming tour in Boswana, Cape Town South Africa, Zimbabwe, and Zambia for a month.
Behind the elephant is the toothbrush tree/bushes.
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Patient Presentation Seminar
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Patient Presentation Seminar
Receptioin area Chobe National Park
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Patient Presentation Seminar
Toothbrush tree= Salvadora persica
Sal
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Patient Presentation Seminar
Toothbrush tree= Salvadora persica
From Wikipedia, the tree encyclopediaIt is also known as Arak, Pilu, mustard tree. It is a species of Salvardora. Salvadora
persica has antiurolithatic (anti-urinary stone/calculi) properties. It is used for centuries
as natural toothbrush. Its fibrous branches have been promoted by World Health
Organization for oral hygiene use. Researches suggest it contains a number of medically
beneficial properties including abrasives, antiseptics, astringent, detergents, enzyme inhibitors, and Fluoride.
Loma Lin da Un iversity
Patient Presentation Seminar
Loma Lin da Un iversity
Patient Presentation Seminar
Salvadora Perci=sica = toothbrush Salvadora persica= toothbrush tree
Loma Lin da Un iversity
Patient Presentation Seminar
Healed Site Immediate Loading
Veneer Provisional on Abutment
D r. auLong NguyenDDS, MAGD
Loma L inda Unive rsity
Patient Presentation Seminar
Patient Demographics
• Gender: female• Age: 67• Race: Caucasian• Marital Status: Single• Employment Status:
Administrator assistant at Stanford University
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Patient Presentation Seminar
Frontal & Profile View At rest
Ms. Sue
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Patient Presentation Seminar
Smile in Frontal and Profile View
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Patient Presentation Seminar
Chief Complaint
“I had 4 dentures for this tooth and many bonded procedures but it didn’t stay. I want to have something fixed.”
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Patient Presentation Seminar
Medical History• BP 99/47; P= 67• ASA II• Patient has asthma, arthritis,
hypertension, stomach ulcers, gout
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Patient Presentation Seminar
Medical History
She is taking 1.Amlodipine2.Lisinopril3.Pentoprazole4.Vitamin B125.No Inhaler6.Allergic to Benzocaine
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Patient Presentation Seminar
Dental History• Sue has several gold and PFM crowns and root
canal therapy in posterior teeth. They are all in good conditions.
• Teeth #s 14 & 15 have extensive recurrent caries with guarded to poor prognosis so she wanted to wait until they bother her then take care of them.
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Patient Presentation Seminar
Dental History
• Acquired missing Tooth # 11 has adequate bone volume BL = 7mm; MD = 8mm; inter-occlusal space = 5mm;
• Cusp tips of #s 21 & 22 would be reduced to give 1mm of interocclusal space.
• Type III bone
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Patient Presentation Seminar
Anterior View
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Patient Presentation Seminar
Protrusive View
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Patient Presentation Seminar
Occlusal Views
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Patient Presentation Seminar
Maximum Intercuspation Views
Right Left
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Patient Presentation Seminar
Working Side Views
Right Left
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Patient Presentation Seminar
Extra-oral Findings• Head and neck: WNL• Facial asymmetries:
None • TMJ: Normal, healthy• Lymph nodes:
nonepalpable
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Patient Presentation Seminar
•Soft tissue exam: mild to moderate gingival inflammation around all molars
Intra-oral Findings
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• Hard tissue exam: moderate bruxism with uniform wear on enamel and crowns of all teeth
• Missing tooth # 11• Several posterior teeth have gold
and PFM crowns.• Moderate to severe recurrent
caries in #s 2M, 18M, 14DB, #15 M.
• Several
Intra-oral Findings
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• Occlusal Scheme:
• Angle Class I occlusion
• Skeletal class I.
Occlusal Findings
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Perio Exam09/01/15
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• AAP: Generalized healthy with localized chronic mild to moderate gingivitis around all molars.
Periodontal Findings
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Radiographic Presentation
June 26, 2015
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Patient Presentation Seminar
June 26, 2015
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Patient Presentation Seminar
• Acquired missing tooth # 11 causes esthetic and functional problems.
• Type III bone• BL= 7mm• MD= 8.5mm• Inter-occlusal space = 5mm• Mild to moderate bruxism
Diagnosis
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• Good to excellent for implant • Fair to Good for prosthesis due to mild to
moderate bruxism
Prognosis
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• 1. Take photos, xrays, scan, take bite registration & alginate impression
for tx plan presentation
• 2. place implant Nobel Biocare 3.5mm*10mm
• 3. Immediate placement of Ti-esthetic custom abutment
• 4. Reduce cusp tips of #s 21 & 22 for proper occlusal clearance
• Take bite registration, final impression with PVS and send to lab
• 5. Make bonded provisional veneer with sand blasting F of abutment
• 6. Deliver crown by cementation; Night Guard
Proposed treatment plan
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Patient Presentation Seminar
Implant and immediate veneer provisional
placed on 8-11, 2015 X-ays of Implant placed 8-11,
I1 week post op 8-18- 2015
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Patient Presentation Seminar
Custom abutment placed 8-11, 2015
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Patient Presentation Seminar
Provisional veneer, 9-1, 2015
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Patient Presentation Seminar
Provisional veneer placed 8-11, 2015
Provisional veneer placed on 8-11-2015 Outof
occlusion
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Patient Presentation Seminar
Provisional veneer placed 8-11, 2015 Out of occlusion
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Patient Presentation Seminar
Lily in the Okavango Delta River
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Patient Presentation Seminar
• Sand Blasting abutment for final cementation
Abutment after provisional was removed
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Patient Presentation Seminar
PFM crown was cemented on September 1, 2015
FiNnal PFM crown placed 9-1, 2015Out of lateral excursion
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Patient Presentation Seminar
CBCT Radiographic PresentationOctober 19-2015
2 month 8 days after Implant placement
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Radiographic Presentation
CBCT Scan
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Follow up post placement of PFM crown on November 6, 2015
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Patient Presentation Seminar
Mauna Laani Coconut grove
r
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Patient Presentation Seminar
• An exposed root is my ideal surgical guide.
Extraction,Immediate Implant
Placement
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Patient Presentation Seminar
Patient Demographics
• Gender: male • Age: 86• Race: Korean• Marital Status: Married• Employment Status: Retired
English Professor
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Patient Presentation Seminar
Front View at Rest and Smile
Mr. Kim
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Patient Presentation Seminar
Profile View at Rest and Smile
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Patient Presentation Seminar
Chief Complaint
“My bridge is loose. I have many old gold crowns. I want strong teeth to chew. Fixed whatever you think wrong.”
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Patient Presentation Seminar
Medical History1.BP= 136/87; P= 672.ASA I3.Pt has hypothyroidism &
Gastroesophageal reflux disease-GERD.
4.He is taking Levothyroxine & Femetidine.
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Patient Presentation Seminar
Dental History Pt has failed PFM bridges #s 2 to 4 & 11-15;
•Teeth #s 19, 31 have recurrent caries under gold crowns
•Pt wanted to have successful implants placed for #s 11, 12, 14 in 2006
•He would like to have teeth #s 2, 3, 4, 19, 31 implants and crowns.
•Pt has fair oral hygiene but doesn’t floss often.
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Patient Presentation Seminar
Anterior View
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Patient Presentation Seminar
Occlusal View
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Patient Presentation Seminar
Occlusal View
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Patient Presentation Seminar
Maximum Intercuspation Views
Right Left
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Patient Presentation Seminar
July 10, 2006
July 10, 2006
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Patient Presentation Seminar
• Bridge #s 11 -15 was removed and sectioned.• # 15 PMF was re-cemented.
• Implants were placed for teeth #s 12, 14 on September 15, 2006 & # 11 on December 1st, 2006.
Pano was taken on August 15, 2006
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Patient Presentation Seminar
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Patient Presentation Seminar
July 10, 2006
July 10, 2006
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Patient Presentation Seminar
• 12- 1, 2006 9-16-2015
9 Years Comparison
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• 8-15-2-06 9-16-2015
9 years post Implant & prostheses placement
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Patient Presentation Seminar
• Teeth #s 2, 4, 15, 19, 31 were removed and implants were placed immediately at extraction time
• Puros cancellous particulate bone graft• There was no primary closure of gingiva at
extraction site• Used chromic resorbable gut interrupted
sutures
Implants placed on7-31, 2014 & 9-16, 2015
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January 16, 2014
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Patient Presentation Seminar
• 3-24-2014 9-16-2015
1.5 Years Post Extraction, Immediate Implant Placement #s 2 & 4
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Patient Presentation Seminar
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Patient Presentation Seminar
• Annual Recall visit 9-16-2015
Extraction and Immediate Placement of # 31 on 9-24-2015
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• 1. Abscence of infection 2. Soft tissue Closure
• 3. Space maintenance 4. Graft Stability
• 5. RAP= Regional Acceleratory Phenomenon
• 6. Host Bone blood supply 7.Growth Factors
• 8. BMP=Bone Morgenetic Proteins
• 9. Healing time
• 10. Defect size and tophography
• 11. Transitional prostheses
Surgical Keys to Bone GraftingCarl Misch- 3rd Edition-Chapter 36-page 839
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Patient Presentation Seminar
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Patient Presentation Seminar
•An exposed root is my ideal surgical guide.
•Puros Cancellous Particulate bone graft & Biomend membrane
Extraction,Immediate Implant
Placement
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Patient Presentation Seminar
Patient Demographics
• Gender: male • Age: 63• Race: Iranian• Marital Status: Married• Employment Status:
Mechanical engineer
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Patient Presentation Seminar
Front View at Rest and Smile
Mr. Riazati
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Patient Presentation Seminar
Profile View at Rest and Smile
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Patient Presentation Seminar
Anterior View
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Patient Presentation Seminar
Protrusive View
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Patient Presentation Seminar
Occlusal View
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Patient Presentation Seminar
Radiographic Presentation 2-2-2015; #s 12, 13
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Patient Presentation Seminar
Radiographic Presentation 2-2-2015; # 19
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Patient Presentation Seminar
Radiographic Presentation 2-2-2015; # 31
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Patient Presentation Seminar
7 month post implant placement
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Patient Presentation Seminar
7 month Post Implant, healing cap removed from # 19
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Patient Presentation Seminar
• 2-2-2015 9-4-2015 11-6-15
• Teeth #s 12, 13
Extraction, Immediate placement, a predictable result
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Patient Presentation Seminar
• 2-2-2015 9-4-2015 11-6-15
• Tooth # 19
Extraction, Immediate placement, a predictable result
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Patient Presentation Seminar
• 2-2-2015 9-4-2015 11-6-15
• Tooth # 31
Extraction, Immediate placement, a predictable result
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Patient Presentation Seminar
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Patient Presentation Seminar
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Patient Presentation Seminar
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Patient Presentation Seminar
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Patient Presentation Seminar
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Patient Presentation Seminar
• MIP-Right side• After Implant and prosthesis
Post-Prosthetic delivery PFM # 31
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Patient Presentation Seminar
• MIP-Left side• After Implant and prosthesis
Post-Prosthetic delivery PFM #s 12, 13, 19
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Patient Presentation Seminar
Radiographic Presentation2-2-2015, 9-4-2015, 11-6-2015
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Patient Presentation Seminar
Radiographic Presentation 11-6-2015, Post PFM crown delivery
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Patient Presentation Seminar
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Patient Presentation Seminar
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Patient Presentation Seminar
• I wish you all peace and happiness.
Thank you for your attention.