Finlay's Case Presentation

Welcome to my April 2023 Newsletter Case Presentation.

This newsletter describes the provision of a complete upper denture and lower implant supported metal based complete denture for Estelle, after implant failure.

This 77-year-old woman was referred to me by her general dental practitioner.

Dental history prior to treatment
Over 15 years 2 courses of maxillary and mandibular implant treatment supporting fixed replacement teeth which had failed owing to implant rejection.

Dental concerns
“Top teeth were removed and replaced by a non-fixed denture on implants. Bone was grafted from my hip and animal bone was required. This is now in place only on two implants. It doesn't fit and requires a lot of fixative. There is significant bone loss I am told there is too little bone for implants other than zygomatic implants. Bottom teeth were removed 4 years ago and implants placed. A bridge was fitted on the implants. This has never been satisfactory as the bridge did not seem to fit. I then got Hodgkin Lymphoma which was aggressively treated by chemotherapy and steroids over a 12 month period. Following my recovery as soon as I could I went to the dentist to find infection and two failed implants that needed to be removed. The bridge is now on implants that are failing due to accelerated bone loss.”

Dental wish list
“To have teeth that I can eat and smile with”
“To have the least invasive option - so am not keen on zygomatic”
“To have less worry every time I open my mouth and to have no pain”
“To reduce my anxiety over my teeth and restore some self-confidence”

Medical History
Hodgkin’s Lymphoma
Psoriasis
Mild heart failure

Medication
Ramopril 10mg
Frusemide 20 mg

Diagnoses
Two failed implants upper left maxilla
One failed implant in lower central incisor region
Two failing implants in lower canine positions
Compromised denture bearing area with extremely resorbed maxilla following two courses of implant placement and failure.
Technically and cosmetically poor upper complete denture
Aesthetically poor lower bridge

Treatment options discussed with Estelle
Do nothing - Estelle did not want this
Upper complete denture and lower implant supported metal based complete denture – Estelle wanted this treatment.
Zygomatic implants supporting replacement upper teeth - Estelle did not want this treatment

The clinical situation and treatment process is shown in detail below with photographs. I provided the clinical work. Rowan Garstang provided the technical work.
If you enjoy my Newsletters and you have friends, colleagues, dental students, dental technicians, clinical dental technicians and postgraduate dentists that you think will appreciate them, please feel free to share them. In addition, if you or your colleagues would like to receive my Newsletters, please email me (education@finlaysutton.co.uk) and I will update the list.

Courses given by Finlay
Removable prosthodontic courses consisting of lectures and live clinical demonstrations
These courses are aimed at general dentists, prosthodontists, clinical dental technicians and dental technicians. They are completely clinical, demonstrating how to provide dentures which have optimal function and superb aesthetics. I give live patient demonstrations along with lectures abundantly illustrated with step-by-step photographs and videos of all procedures. Delegates will take many “nuggets of gold”, being able to put the advice straight into practice with immediate improvement in professional satisfaction and patient outcomes.

Please see details of courses and lectures (in UK and rest of the world) to be given by Finlay over during 2023 at the end of this Newsletter

education@finlaysutton.co.uk

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