-
Overwhelming case!!!
New patient exam. 62 yo female no remarkable medical history.
Patient’s CC: “My top teeth are failing, I want to fix them but I want something that is not removable”
Maxillary arch: 5 implants – 3 restored
Mandibular arch: Kennedy class 2, severe anterior attrition
Implants were placed by a periodontist.
Maxillary teeth don’t look great, neither do the mandibular teeth but I think they could be restored.
Pt was recommended at previous office to add 2 anterior implant on Mx arch and restore her with an implant bridge.
Her VDO, curve spee and everything is collapsed. I think prior to placing any more implants I should work on restoring her VDO.
I ended up referring this patient to my local Prosthodontist but I would like feedback of what steps should have been taken to restore her VDO prior to adding more implants/converting her to a fixed prothesis.
Extra info: She was also concerned about finances and did not want to treat her mandibular teeth.
What are your thoughts?? how would you have approached this case? @ivan-chicchon
Jedediah, Nolan and Ivan8 Comments-
Wow, this looks like a challenging case!
Definitely needs a full mouth restoration and getting back that lost vertical dimension. How did the patient feel about going for a full arch prosthesis on the maxilla?
1 -
This one is very tough, but also a very solvable case.
Right off the bat, to start a case and see it through properly, I would ballpark the cost to be about $50,000 at least for her to complete treatment for both arches.
Not to say that she has to do the FULL treatment for everything right away. She can surely do the upper arch to ideal treatment and then some temporary measures on the lowers (ie instead of crowns, do full contour composite) This staging of the treament can make it more feasible
2-
@ivan-chicchon wow 50k ballpark? 🤣🤣🤣🤣
On my side of the world this is 20k at most!
2-
@javohiros sadly this reminds me of how much I pay for milk…and mortgage! 😂😭😭😭would love to visit your side of the globe.
1
-
-
-
It helps to take a step back and think of the big steps that will lead to stability.
1. Her upper arch is pretty confusing. Lots of things going on up there. Can we create a blank slate and provide a simple solution? Removing the upper teeth and rebuilding with an AllonX prosthesis seems like it will be predictable and have good longevity. This will have to be in a temporary for some time until you get the VDO dialed ini.
2. Her lower arch needs posterior stops and we need to build up the VDO. So let’s do just that. Get some wax rims and assess opening her up. You can get a temporary partial denture to open her bite up 7mm. Then you can use some composites to build up the anterior teeth. They’re not permanent, but can give you some diagnostic testing and will improve the situation considerably.
3. Once you and her have gone back and forth a bit on VDO, you can start finalizing the arches. LIkely with implants in the posterior mandible and crowns in the anterior mandible.
2 -
Now that there is some sort of big picture plan, and if the patient is able to fund the ballpark fees, then you can get to the nitty gritty of planning step by step what needs to happen at each appointment. That’s where i sit down for an hour at the computer and list out every appointment. I’ll still miss something. But then it helps paint a picture of the 15+ appointments you’ll be having with the patient.
2 -
Thanks for the guidance. I referred patient to my local prosthodontist but I think is a good learning case!!
Thanks again1 -
I applaud you for referring this case on to the prosthodontist. It’s easy to see $$$$ and want to do something like this.. it’s a lot harder to tell the patient they are better off with someone else handling the case
-
