Ultimate Makeover With Computer Guided Dental Implant Surgery

Faced with a diagnosis of periodontally hopeless teeth with advanced mobility, significant bone loss, and poor esthetics, Bill felt torn about what to do. He sought other opinions. Three years after his heart surgery, Bill returned to Prosthodontics Intermedica for another comprehensive prosthodontic evaluation. His prosthodontist recommended extraction of all of his teeth, while his periodontist suggested that a few teeth might be saved and used to fabricate a tooth-supported restoration.


Due to the advanced bone loss and tooth mobility, Bill was told that conventional treatment would be too unpredictable. He opted to have all his teeth removed. Since he felt financial restraints wouldn’t permit him to replace all his teeth with implants immediately, Bill chose, instead to receive Teeth in a Day in his lower jaw, while having a denture created for the upper jaw.


At the time of extraction, all the soft tissue and abscesses were removed from the tooth sockets. Seven Brånemark implants (Nobel Biocare, Yorba Linda, California) were then immediately placed in the lower jaw, and a Teeth in a Day prosthesis was created to fit on top of them. Bill went home that day wearing an immediate complete upper denture. In the days that followed, he reported very little pain or discomfort and only minimal swelling. Three months later, he received permanent versions of both the denture and the implant-supported prosthesis.


“The lower jaw restoration felt just like my own teeth,” Bill recounts. “I was thrilled.” In fact, he felt so enthusiastic about the initial change in his appearance that he consulted a plastic surgeon. He had become dissatisfied with the excess facial tissue that he felt made him look tired and older than his years. He subsequently had a facelift, brow lift, and an eyelid lift, along with the placement of a chin implant to enhance his jawline. Although delighted with his new appearance and implant-supported teeth, Bill found the upper denture to be uncomfortable despite many adjustments and efforts to reline it. He finally concluded that replacing the upper denture with implant-supported teeth was no longer something he could regard as a luxury; it had become a necessity. A new Nobel Biocare surgical protocol – Teeth in an Hour Computer Guided Dental Implant Surgery had just become available. This type of treatment allows patients to receive their implants and new teeth in about 35 minutes, versus the two to three hours required by the Teeth in a Day procedure.

Moreover, the patient leaves the prosthodontic office with a reinforced definitive prosthesis. This is all made possible due to the use of pre-surgical three-dimensional computer planning that allows for the fabrication of a highly precise definitive restoration before the surgery. Informed about this opportunity, Bill was eager to proceed. Since his upper denture looked good, an impression of it was made, and a clear copy of it was fabricated. Numerous radio-opaque markers were then placed within the clear denture. With that denture in the mouth, a CT scan was taken. Another scan was taken of the clear denture itself. Working on a computer, these scans were aligned using the radio-opaque markers, and the surgeon determined exactly how the implants needed to be placed to achieve the best possible esthetic result.


This information was then sent digitally to Nobel Biocare in Sweden where a computer-guided the machining of a surgical guide that would help guarantee proper implant placement. On the day of surgery, 20cc of blood was drawn and platelet-rich plasma (PRP, Harvest Technology) was harvested from the blood. Applying the platelet-rich plasma to the surgical area has been shown to expedite healing. Six small receptor sites were then precisely created in the upper jaw, exactly where the surgical guide dictated that they be positioned. Five 13mm-long Brånemark implants and one 15mm-long Brånemark implant were coated with the platelet-rich plasma and placed into the surgical site. Abutments were connected to the implants, and the carbon-fiber-reinforced acrylic prosthesis that was created in advance was screwed into place on the abutments.

The post-operative instructions given were the same as those that Bill had received after his Teeth in a Day procedure. These included using ice for the first 40 hours and sticking to a moderately soft diet for a 12-week period. In addition, Bill was provided with antibiotics, pain medications, and steroids. The following day, he reported only the mildest discomfort and no swelling. When compared to those receiving implants placed following a standard protocol, patients receiving Nobel Biocare’s Teeth in an Hour  Computer Guided Dental Implant Surgery typically exhibits very little to no pain or discomfort. This is due to the brevity of the surgical procedure and the fact that the gum tissue is subjected to minimal trauma during the placement of the Brånemark implants.

Today Bill, who enjoys an active lifestyle, professes to be “awed” by the outcome of his surgeries. “I always wanted to look like Don Johnson,” he confides. He smiles—the smile of a man who has achieved a dream.

Computer Guided Dental Implant Surgery uses pre-surgical three-dimensional computer planning, allowing fabrication in advance of a highly precise final restoration.

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Pi Dental Center, Fort Washington, PA