J Korean Acad Prosthodont.  2019 Oct;57(4):416-424. 10.4047/jkap.2019.57.4.416.

Full mouth rehabilitation in a patient with peri-implantitis: A case report

Affiliations
  • 1Department of Prosthodontics, School of Medicine, Ewha Womans University, Seoul, Republic of Korea. prosth@ewha.ac.kr

Abstract

Peri-implantitis appears in almost 20% of patients who received implant treatment, and increase in its number is inevitable as time goes by. Although it can be treated by both non-surgical and surgical procedures, in cases which include severe bone loss, explantation and rehabilitation may be necessary. Careful treatment planning and considerations to prevent recurrent peri-implantitis should be taken into account. In the following case presented, a patient with chronic periodontitis and peri-implantitis was successfully rehabilitated after removal of several implants. Extraction and explantation of multiple teeth and implants were followed by full mouth reconstruction with fixed implant prostheses on the mandible and implant retained overdenture on the maxilla. Surgical and prosthetic measures to prevent recurrent peri-implantitis were taken into consideration.

Keyword

Peri-implantitis; Full mouth rehabilitation; Zirconia; Computer-aided design and computer-aided manufacturing (CAD/CAM); Implant removal

MeSH Terms

Chronic Periodontitis
Denture, Overlay
Humans
Mandible
Maxilla
Mouth Rehabilitation*
Mouth*
Peri-Implantitis*
Prostheses and Implants
Rehabilitation
Tooth

Figure

  • Fig. 1 Pre-operative intraoral view (A – E). (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view.

  • Fig. 2 Pre-operative panoramic X-ray showing generalized alveolar bone loss.

  • Fig. 3 Diagnostic wax-up and arrangement on diagnostic model. (A) Right lateral view, (B) Fontal view, (C) Left lateral view.

  • Fig. 4 Provisional restorations. (A) Right lateral view, (B) Frontal view, (C) Left lateral view (Yellow arrow shows less interproximal space under provisional restorations).

  • Fig. 5 Prosthetic process for final restorations. (A) Master cast of maxilla, (B) Master cast of mandible, (C) Bite registration with wax-rim on maxilla and fixed bite jig on mandible, fabricated with titanium temporary cylinders and pattern resin.

  • Fig. 6 (A) Computer-aided design of final restorations, (B) Computer-aided design of custom abutments, (C) Try-in of custom abutments.

  • Fig. 7 Fabricated final restorations. (A) Right lateral view, (B) Frontal view, (C) Left lateral view. Over-contour was minimized and sufficient interproximal spaces were provided.

  • Fig. 8 (A) Conventionally cured maxillary denture, (B) Preparation of denture teeth (premolars and molars), (C) Computer-aided design of zirconia crowns, (D) Final maxillary denture with zirconia crowns on premolars and molars for additional resistance from attrition by antagonistic mandibular zirconia restorations.

  • Fig. 9 Panoramic X-ray after mandibular prostheses delivery.

  • Fig. 10 Definitive restorations (A – E). (A) Maxillary occlusal view, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Mandibular occlusal view (Yellow arrow shows adequate interproximal space under definitive restorations).

  • Fig. 11 T-Scan of definitive prostheses showing bilaterally balanced occlusion. (A) Left lateral movement of mandible, (B) Maximum intercuspation, (C) Right lateral movement of mandible.


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