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Vol. 8, No. 2 August 1995 Insights Newsletter Continues:Page 3
Torus Necessitates Maxillary Implant Rehabilitation
Balshi T
Treatment of older patients presents distinct challenges in prosthodontic rehabilitation. One such example is a 90 year old female patient who was referred to Pi Dental Center for the treatment of a failing maxillary fixed prosthesis. Due to her inability to wear a removable denture, it was a challenge to provide her with continued fixed prostheses throughout the implant treatment reconstruction.
The patient's medical history revealed rheumatism, arthritis and recent frequent occurrences of pneumonia. She was sensitive to Penicillin and was medicated with Prednisone every other day.
The patient's dental history included fixed prostheses restoring both mandibular posterior quadrants and a failing, mobile fixed prosthesis and multiple missing teeth in the maxilla.
The maxillary left molars were periodontally and restoratively hopeless. Radiographic examination of the maxillary teeth could only be accomplished with panradiographic (Fig 1) due to the enormous torus palatinus which totally obliterated the palate. This extosis extended beyond the occlusal surface and incisal edges of the maxillary dentition. The patient was reluctant to consider surgical intervention to remove this overgrowth of bone.
The treatment plan prescribed the Brånemark method of osseointegration (Class III modification). Three of the remaining natural teeth (#'s 7, 10, and 15) were selected to serve as temporary abutments to support a fixed prosthesis (Fig 2). A wire reinforced heat processed acrylic provisional restoration was prepared in advance.
Using local anesthesia, teeth #'s 6,8,9,11 and 16 were removed. Brånemark implants were placed in the pterygomaxillary region bilaterally and six additional implants were inserted in the anterior region. Following implant placement and full flap closure the provisional fixed prosthesis was cemented. The patient was comfortable postoperatively with little swelling or ecchymosis.
Following a five month healing period, angulated abutments were placed on the six anterior implants and a standard abutment on the pterygomaxillary implant on the left side. Its counterpart on the right side was not osseointegrated and was therefore removed.
A porcelain fused to gold fixed prosthesis (Fig 3 & 4) was constructed using the seven Brånemark implants. A short cantilever provided additional function and esthetics for the right side (Fig 5 & 6).
The patient is able to perform adequate oral hygiene and has excellent masticatory function. She reports delight in chewing food without discomfort or fear of loosing her maxillary teeth.
Patients in later years are indeed good candidates for osseointegrated implants ad modem Brånemark. This 90+ year old patient had excellent bone growth response to the titanium implants permitting a solid fixed restoration. This certainly is a significant contribution to maintaining her quality of life and the ability to function orally.
Acknowledgement: Fort Washington Dental Lab, Inc. for construction of the porcelain fused to gold tissue integrated prosthesis.
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Panradiograph showing severe periodontal deterioration of the two remaining maxillary molars and the anterior teeth.
Panradiograph following selective extractions and placement of eight Brånemark implants. Wire reinforced provisional restoration is supported by three remaining natural teeth.
Porcelain fused to gold maxillary implant supported prosthesis in centric relation.
Frontal view of maxillary fixed prosthesis and extensive torus.
Postop panradiograph of the final maxillary prosthesis supported by seven implants. Note the three remaining teeth (#'s 7,10, 15) have been removed.
Postoperative full face view with the final prosthesis fastened to 7 Brånemark implants.
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