A 67-year-old male patient presents at the surgical clinic with a reduced number of teeth in both jaws (Figs 1-4). All teeth are discoloured and several have root fillings, restorations and secondary caries. There is also a generalized loss of periodontal attachment, combined with gingival recession and wedge-shaped cervical defects caused by tooth brushing in the maxilla. Medically, he suffers from hypertension and type-2 diabetes mellitus, with both conditions under internist control.
As a preliminary treatment by the referring dentist, tooth #33 had to be extracted due to an endo-periodontal lesion (Fig. 1). Tooth #44 has secondary caries, periodontal pockets with bleeding on probing, grade 3 mobility and is assessed as hopeless. Teeth #34 and #35 also show reduced periodontal support, and grade 2 mobility. The patient agrees to have all remaining mandibular teeth removed in favour of a purely implant-retained prosthesis.
In regard of the planned implant therapy the radiographic assessment (Fig. 1) and clinical examination (Figs. 2-4) reveal severe vertical and horizontal alveolar bone resorption in the posterior maxilla. In the mandible there is a moderate vertical resorption, with narrow ridges in the edentulous areas and a lack of vestibular fornix depth, especially in the interforaminal region.
The patient wears removable tooth-supported partial dentures, with a cast frame in the maxilla (Figs. 5-6). The vertical intermaxillary dimension is reduced (Fig. 4), and both dentures are unstable, preventing the patient from eating or speaking well, which is his chief complaint.
As a cause-related treatment before the onset of implant therapy, the patient receives a professional tooth cleaning, careful oral health instructions, and initial periodontal debridement.