Treatment Planning and Sequence for Implant Therapy in a Young Adult With Generalized Aggressive Periodontitis
Treatment planning for full-mouth rehabilitation in patients with generalized aggressive periodontitis often requires a staged approach. Few articles have addressed treatment planning and sequencing issues in this patient population. This report describes the multidisciplinary management of a young adult by a combination of periodontal and implant therapy and rehabilitation with fixed prostheses. At a 2-year follow-up, the patient's periodontal health and peri-implant conditions were stable. Prosthodontic rationale and treatment planning concepts in a patient with multiple challenges are discussed.
Figure 1. Pretreatment radiograph of the patient revealing bone loss associated with generalized aggressive periodontitis. Figure 2. Pretreatment profile image of the patient showing a convex profile with prognathic maxilla and mandible. Figure 3. Panoramic radiograph after extraction of maxillary and mandibular posterior teeth. Mandibular left premolar was in articulation with maxillary canine and was retained for maintenance of occlusal vertical dimension. Figure 4. Frontal view of the teeth in maximum intercuspation after extraction of posterior teeth. Note the anterior crossbite and the pseudopockets around the mandibular anterior teeth.
Figure 5. Diagnostic waxing for immediate maxillary complete denture and mandibular posterior teeth for fabrication of surgical guide for implant surgery. Figure 6. Profile image of the patient after being made edentulous in the maxilla. Notice obvious loss of lip support in comparison to Figure 2. Figure 7. Duplicate of the diagnostic denture used for radiographic and surgical guide purposes. Figure 8. Autogenous block graft harvested from the ramus being placed in the anterior maxilla in the lateral incisor regions. Figure 9. Frontal view of the immediate maxillary complete denture and definitive mandibular fixed partial dentures (FPDs) in maximum intercuspation. The FPDs were inserted during the healing process of the maxillary bone grafts. Figure 10. Six implants were placed in the planned positions of the maxilla. Notice the parallelism between the implants.
Figure 11. Master cast showing the effect of lingualization of the access holes with the help of angulated abutments. These were necessary to compensate for the implants placed in the patient's proclined maxilla. Figure 12a. Occlusal view of the final prosthesis after insertion. Note the lingualized position of the anterior access holes. Figure 12b. Frontal view of the final prostheses in maximum intercuspation. An end-to-end anterior occlusion was required to compensate for the labially inclined mandibular anterior teeth and correction of the pretreatment anterior crossbite. Figure 13. Profile image of the patient with final prosthesis. Note restoration of lip support to pretreatment condition. Compare with Figures 2 and 6.
a. Periapical radiographs of all implants taken at a 4-month follow-up. b. Periapical radiographs of all implants taken at a 2-year follow-up show bone levels within normal limits. Compare with Figure 14a.
Posttreatment close-up smile of the patient with definitive prostheses.
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