Article 13

Immediate Loading with Many Complicated Factors (severe periodontal disease, collapsed occlusion, Immediate extraction)

INTERNATIONAL JOURNAL OF FUTURE DENTISTRY

2022:Vol. 2:No. 1: 71-78

Dr. Myungho Lee

The patient was born in 1970 and had a good systemic condition. He visited our clinic due to severe periodontal disease at a young age. He is doing a lot of work. Based on the diagnosis, it was decided to extract all his teeth. As he is young, implants are chosen over dentures. (Fig. 1,2,3)

Fig. 4 Immediate extraction at mandible

Fig. 5 Immediate extraction at maxillary

Among the many options for a treatment plan, all the upper and lower teeth are extracted at once. (Fig. 4, 5)

Different types of implants are used, including internal and external implant types. Various implant threads are also used. For slightly soft bone, Any Ridge threads work well for primary stability. When using an implant with a platform between the implant and the abutment post, the bone surrounding the implant can be preserved. The implants are placed in the maxilla
and mandible with bone grafting on the day of surgery. (Fig. 6)

Socket elevation is done in the posterior maxilla. A lot of bone needs to be grafted into the bone defects in the upper and lower extraction sockets and the maxillary sinus. (Fig. 9)

Various bone types are used for the bone grafting. The structure of the bone is considered the most important.. It should have good porosity, and good wettability facilitates the formation of blood vessels. However, some products are treated at high temperatures to remove organic materials, which changes the bone material structure leaving no pores.

Growth factors (BMP, PRP) are utilized. The outcome seems to be better when autogenous bone is mixed. Membranes are hardly used. They are only used for space maintenance when a lot of bone is grafted horizontally and vertically. (Fig. 7, 8)

Fig. 9 Implant placement. Bone defect in Maxillary

Fig. 11 Appearance 1 month after surgery

Fig. 8 Bone graft on mandible - PRP spray - NO Membrane

The teeth are fabricated on the day of surgery and immediately loaded. Based on our experience, 4 to 6 implants can be loaded immediately. (Fig. 10, 11, 12, 13)

Fig. 10 Post. suture. temporary crown , immediate loading

Fig. 12 Reinforced with metal for temporary crown strength - upper, fower arch

Fig. 13 Time change and implant placement

For temporary prostheses, many factors such as comfort, balance, esthetics, chewing, food retention, and the ability to brush teeth need to be checked. Also, a one-piece prosthesis cannot be made with scanning, as areas with curvature are still challenging. So, impression-taking is performed (Fig. 14, 15, 16, 17, 18)

Fig. 14 Maxillary and mandibular impression
- Resin block to increase contact surface with impression.

Fig. 18 Temporary teeth in Model

After everything is stabilized in the temporary prostheses used by the patient, an anterior jig can be made with an articulator after taking an impression.
This can be useful for guiding the prosthesis. (Fig. 19, 20, 21)

Fig. 20 Post and temporary crown

Fig. 15 Denture concept -aesthetic, vertical dimension, CR check

Fig. 16 Post milled to match wax rim

Fig. 17 Gothic arch tracer for CR -centric point

Fig. 19 Temporary teeth in Oral Cavity

Fig. 21 Anterior jig -after using tempory crown, impression and jig made
in front.

Today, a modeless approach is popular in dental clinics. With the advancement of oral scanners and 30 printers, a lot has become possible. However, in
most cases, it uses average values. Using average numbers in prostheses may work for a static centric point, but not for a dynamic eccentric area, which is
the actual chewing pattern of a patient. Each person's chewing pattern is unique and should be reflected in the prostheses. This is due to the different skeletal forms, including the temporomandibular joint, in each individual. (Fig. 22)

Fig. 22 Digma for condyle guidance, anterior guidance data

Fig. 24 Occ/usa/ adjustment using articulator

Prostheses are fabricated using analog and digital approaches and are adjusted on an articulator. Many companies are trying to adopt a more modeless concept, incorporating facial photos, scans, CT, and oral movement recordings in one device. (Fig. 23, 24, 25, 26)

Fig. 27 Biopsy results -well formed bone -Haversian canal

X-rays are taken regularly to observe changes. (Fig.28, 29, 30)

Fig. 28 Check up, final prosthetics

The patient has been using the prostheses satisfactorily for a long period of time. (Fig. 31)

Fig. 23 Cad Cam

Fig. 25 Final prostheses in mouth

Fig. 26 For biopsy (lower left) -no trephining

Fig. 29 Standard view (2015) -grafted bones visible
-Various types of implant, -platform switching

Fig. 30 Standard view (2020) -shows stability of grafted bone

Immediate loading after extraction has been used for more than 25 years in many patients. It reduces the treatment time for both patients and dentists, and patients are very satisfied with the ability to chew and the esthetics. (Fig. 32)

Fig. 32 Before and after treatment