Prosthetically Driven Therapy for a Patient With Systemic Lupus Erythematosus and Common Variable Immunodeficiency: A Case Report
Patients who have systemic diseases in conjunction with severely resorbed maxillary and mandibular bone present challenges for dental implant therapy and rehabilitation. This case report describes the interdisciplinary comprehensive treatment completed on a patient with systemic lupus erythematosus (SLE) and common variable immunodeficiency (CVID). Patients with these systemic conditions present a multifactorial challenge for dental treatment due to advanced carious lesions, missing teeth, lack of adequate bone quality and quantity, as well as secondary effects of their medications. The sequence of treatment presented allowed for the necessary case control to ensure successful, predictable reconstruction of the edentulous patient with limited bone available for implant placement. For this patient, we used a combination of autogenous iliac bone graft, bilateral maxillary sinus lifts with BMP-2, transitional implants, and dental endosseous root form implants. Digital dentistry aided in designing the final implant supported fixed restorations. Transitional implants eliminated the need for tissue-borne prostheses, avoiding pressure to the graft and implants. Digital dentistry allowed for prosthetically driven implant placement and a functional, esthetic result. The techniques and staging presented for implant placement and rehabilitation can be used for other patients presenting with similar challenging conditions.
(a) Initial frontal full smile. (b) Initial frontal intraoral view. (c) Initial maxillary occlusal view. (d) Initial mandibular occlusal view.
Pre-operative cone beam computer tomography scan.
Figure 3. (a) Surgical guide with surgical marker for ideal position of the implants. (b) Existing bone ridge with surgical mark of ideal implant position. Figure 4. (a) Sectioning of the cortical hip bone. (b) Stabilization of the bone graft with stabilization titanium screws. Figure 5. Maxillary occlusal view after placement of transitional implants.
Figure 6. (a) Intaglio view of maxillary interim complete denture. Note complete flange reduction and resilient silicone reline. (b) Frontal view in maximum intercuspation of maxillary and mandibular interim complete dentures adjusted and delivered after surgery. Figure 7. Postoperative panoramic radiograph. Figure 8. Intraoral frontal view of transitional implants 4 months after healing. Figure 9. Placement of maxillary implants using the stabilized surgical guide.
Figure 10. (a) Maxillary implant placement and view of the available healed ridge after grafting. (b) Mandibular implant placement and view of the available healed ridge after grafting. Figure 11. Panoramic radiograph after maxillary and mandibular implant placement.
Screenshot of digital planning after determination of implant and teeth position.
Screenshot of digital planning of titanium framework for final maxillary restoration.
Figure 14. Right lateral view of master casts articulated with milled titanium framework for the final fixed dental prosthesis. Figure 15. Panoramic radiograph of final restoration delivered. Figure 16. (a) Intraoral frontal view of delivered final maxillary and mandibular implant supported restorations. (b) Final frontal full smile.
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