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TEETH IN A DAYTM in the Upper Jaw
TJ Balshi and GJ Wolfinger
Introduction
Patients who gag easily or are unable to wear removable dentures are primary candidates when considering a TEETH IN A DAYTM rehabilitation.
The protocol for an implant supported non-removable prosthesis in just one day, which we call TEETH IN A DAYTM, began nearly eight years ago at Pi Dental Center with immediately loading dental implants in edentulous mandibles. These rehabilitations were successful in the mandibular arch because of the superior quality and bone density in the anterior of the lower jaw.
Patient needs and requests soon led to immediate loading of dental implants in the maxilla, or upper jaw. The following patient report represents a culmination of circumstances that lead to the decision to immediately load the maxillary arch using the TEETH IN A DAYTM protocol. Maxillary implants were loaded at the time of placement and were combined with a few implants that had been previously osseointegrated in order to restore ideal form and function throughout the arch.
A patient becomes a candidate for a TEETH IN A DAYTM procedure after assessing their dental history, their medical conditions, the current clinical and radiographic status of their teeth and oral structures, and establishing a clear understanding of the patient's needs and desires.
A 54-year-old female patient was referred with a history of over 30 years of crowns and fixed partial dentures in both the maxilla and mandible (Fig 1). These restorations were supported by endodontically treated teeth that continued to deteriorate due to a compromised dentition and parafunctional habits. Over time the parafunctional habits of bruxing and clenching were responsible for multiple root fractures and the loss of numerous teeth (Fig 3). Her primary concern was to avoid wearing a complete removable maxillary denture.
The patient's medical history indicated good general health. Medications used at the time of treatment included Zyrtec for allergies, Vioxx for pain, Evista to supplement hormone replacement therapy and Periostat to control periodontal inflammation. She did report having sensitivity to penicillin.
In evaluating her dental condition, the maxillary arch was in a state of complete deterioration (Fig 4a,b,c). The only signs of stability in the maxilla were three Brånemark osseointegrated implants that had been successfully placed in 1992 in the right bicuspid and molar area. The remaining natural dentition in the maxilla (teeth #'s 6-15) had completely deteriorated and the patient was experiencing cosmetic and esthetic compromise due to the discoloration and fracture of these provisional restorations. The mandibular dentition suffered with failing traditional fixed prosthodontics in the left posterior and the loss of molars on the right side (Fig 5).
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