Edited by
Nadeem Karimbux, DMD, MMSc
Professor of Periodontology
Associate Dean
Academic Affairs
Tufts University School of Dental Medicine
Boston, MA
USA
and
Hans-Peter Weber, DMD, DrMedDent
Professor and Chair
Department of Prosthodontics
Tufts University School of Dental Medicine
Boston, MA
USA
This edition first published 2017 © 2017 by John Wiley & Sons, Inc.
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Library of Congress Cataloging-in-Publication Data
Names: Karimbux, Nadeem, editor. | Weber, Hans Peter, 1950- editor.
Title: Clinical cases in implant dentistry / edited by Nadeem Karimbux and
Hans-Peter Weber.
Other titles: Clinical cases (Ames, Iowa)
Description: Ames, Iowa : John Wiley & Sons, Inc., 2017. | Series: Clinical
cases | Includes bibliographical references and index.
Identifiers: LCCN 2016036137 (print) | LCCN 2016037395 (ebook) | ISBN
9781118702147 (paper) | ISBN 9781119019930 (pdf) | ISBN 9781119019923
(epub)
Subjects: | MESH: Dental Implantation | Dental Prosthesis Design | Case
Reports
Classification: LCC RK667.I45 (print) | LCC RK667.I45 (ebook) | NLM WU 640 |
DDC 617.6/93–dc23
LC record available at https://lccn.loc.gov/2016036137
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: top middle – courtesy of Do-Gyoon Kim
Paulina Acosta
Private Practice
Tijuana, Baja, CA, USA
Mohammed N. Alasqah
Periodontist and Esthetic Dentistry
Assistant Professor
Department of Preventive Dental Sciences
College of Dentistry
Prince Sattam Bin Abdulaziz University
Al Kharj, Saudi Arabia
Abdullah Al Farraj Aldosari
Director of Dental Implant and Osseointegration Research Chair
Associate Professor and Consultant of Prosthodontics and Implantology
Department of Prosthetic Science
College of Dentistry
King Saud University
Riyadh, Saudi Arabia
Shatha Alharthi
Advanced Graduate Resident
Department of Periodontology
School of Dental Medicine
Tufts University
Boston, MA, USA
Emilio Arguello
Clinical Instructor
Division of Periodontology
Department of Oral Medicine, Infection, and Immunity
Harvard University School of Dental Medicine
Boston, MA, USA
Federico Ausenda
Advanced Graduate Resident
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Gustavo Avila-Ortiz
Assistant Professor
Department of Periodontics
University of Iowa, College of Dentistry
Iowa City, IA, USA
Christopher A. Barwacz
Assistant Professor
Department of Family Dentistry
University of Iowa, College of Dentistry
Iowa City, IA, USA
Seyed Hossein Bassir
Division of Periodontology
Department of Oral Medicine, Infection and Immunity
Harvard School of Dental Medicine
Boston, MA USA
Francesca Bonino
Advanced Standing Student for Internationally Trained Dentists
Henry M. Goldman School of Dental Medicine
Boston University
Boston, MA, USA
Suheil M. Boutros
Private practice limited to periodontics and dental implants
Grand Blanc, MI, USA;
Visiting Assistant Professor
Department of Periodontics and Oral Medicine
The University of Michigan
Ann Arbor, MI, USA
Eriberto Bressan
Professor
Department of Neuroscience
University of Padova
Padova, Italy
Minh Bui
DMD Candidate
Department of Diagnosis & Health Promotion
Tufts University School of Dental Medicine
Boston, MA, USA
Michael Butera
Prosthodontist
Private Practice
Boston, MA, USA
Jacinto Cano-Peyro
Periodontist, Private Practice
Marbella, Spain;
Visiting Professor, Department of Restorative Dentistry
Complutense University of Madrid
Madrid, Spain
Chun-Jung Chen
Instructor in Periodontics
Department of Dentistry
Chi Mei Medical Center
Tainan, Taiwan
Sung Mean Chi
Prosthodontist
Private Practice
Stow, OH, USA
Sung-Kiang Chuang
Associate Professor in Oral and Maxillofacial Surgery
Massachusetts General Hospital and Harvard School of Dental Medicine
Boston, MA, USA
Luis Del Castillo
Clinical Assistant Professor
Department of Prosthodontics
Tufts University School of Dental Medicine
Boston, MA, USA
Rustam DeVitre
Director of Alumni
Tufts University School of Dental Medicine
Boston, MA, USA;
Private Practice
Boston, MA, USA
Irina Dragan
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Satheesh Elangovan
Associate Professor
Department of Periodontics
The University of Iowa College of Dentistry
Iowa City, IA, USA
Karim El Kholy
Advanced Graduate Resident
Division of Periodontics
Department of Oral Medicine, Infection, and Immunity
Harvard School of Dental Medicine
Boston, MA, USA
Waeil Elmisalati
Clinical Assistant Professor of Periodontology
University of New England College of Dental Medicine
Portland, ME, USA
Zameera Fida
Associate in Pediatric Dentistry
Boston Children’s Hospital
Boston, MA, USA
Marcelo Freire
Advanced Graduate Resident
Division of Periodontology, Oral Medicine, Infection and Immunity
Harvard School of Dental Medicine
Boston, MA, USA
Rumpa Ganguly
Assistant Professor and Division Head
Oral and Maxillofacial Radiology
Department of Diagnostic Sciences
Tufts University School of Dental Medicine
Boston, MA, USA
Hamasat Gheddaf Dam
Adjunct Assistant Professor in Prosthodontics
Tufts University School of Dental Medicine
Private Practice
Boston, MA, USA
Hadi Gholami
Research Fellow
Department of Prosthodontics
Tufts University School of Dental Medicine
Boston, MA, USA
Mindy Sugmin Gil
Visiting Postgraduate Research Fellow
Department of Oral Medicine, Infection, and Immunity
Harvard School of Dental Medicine
Boston, MA, USA
Luca Gobbato
Clinical Instructor
Department of Oral Medicine, Infection and Immunity
Division of Periodontics
Harvard University School of Dental Medicine
Boston, MA, USA
Maria E. Gonzalez
Clinical Assistant Professor
Division of Operative Dentistry
Comprehensive Care Department
Tufts University School of Dental Medicine
Boston, MA, USA
Mitchell Gubler
Advanced Graduate Resident
Department of Periodontics
University of Iowa College of Dentistry
Iowa City, IA, USA
Sergio Herrera
Post Graduate Resident
International Academy of Dental Implantology
San Diego, CA, USA
Daniel Kuan-te Ho
Assistant Professor
Department of Periodontics
School of Dentistry
University of Texas Health Science Center at Houston
Houston, TX, USA
Hsiang-Yun Huang
Private Practice
Taipei, Taiwan;
Clinical Instructor
School of Dentistry
National Defense Medical Center
Taipei, Taiwan
Yong Hur
Assistant Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Y. Natalie Jeong
Assistant Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Nadeem Karimbux
Division of Periodontology
Department of Oral Medicine, Infection and Immunity
Harvard School of Dental Medicine
Boston, MA, USA;
Professor of Periodontology
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Ioannis Karoussis
Assistant Professor of Periodontology
Dental School
University of Athens
Athens, Greece
David Minjoon Kim
Associate Professor
Director, Postdoctoral Periodontology
Director, Continuing Education
Division of Periodontology
Department of Oral Medicine, Infection & Immunity
Harvard School of Dental Medicine
Boston, MA, USA
Samuel Koo
Assistant Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Chun-Teh Lee
Post-Doctoral Fellow in Periodontology
Harvard School of Dental Medicine
Boston, MA, USA
Samuel Lee
Director of International Academy of Dental Implantology
San Diego, CA, USA
Paul A. Levi, Jr.
Associate Clinical Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Diego Lops
Assistant Professor in Periodontology and Implant Dentistry
University of Milan
Milan, Italy
Lauren Manning
Assistant Professor
Oregon Health & Science University
Portland, OR, USA
Sonja Mansour
Assistant Professor
Department of Prosthodontics
Institute for Dental and Craniofacial Sciences
Charité
Berlin, Germany
Mariam Margvelashvili
Postdoctoral Fellow
Department of Prosthodontics
Tufts University School of Dental Medicine
Boston, MA, USA
Fabio Mazzocco
Visiting Professor
Department of Implantology at Padova
University of Dental Medicine
Padova, Italy
Luigi Minenna
Research Centre for the Study of Periodontal and Peri-Implant Diseases
Department of Periodontology
School of Dentistry
University of Ferrara
Ferrara, Italy
Adrian Mora
Post Graduate Resident
International Academy of Dental Implantology
San Diego, CA, USA
Lorenzo Mordini
Advanced Graduate Resident
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Hidetada Moroi
Assistant Clinical Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Zuhair S. Natto
Visiting Assistant Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA;
Assistant Professor
Department of Dental Public Health
School of Dentistry, King Abdulaziz University
Jeddah, Saudi Arabia
Christina Nicholas
Department of Anthropology and Dows Institute for Dental Research
The University of Iowa College of Dentistry
Iowa City, IA, USA
Yumi Ogata
Board Diplomate
American Board of Periodontology
Assistant Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Rory O’Neill
Associate Clinical Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA;
Clinical Professor of Dentistry
Roseman University
College of Dental Medicine
Henderson, NV, USA
Pinelopi Pani
Advanced Graduate Resident
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Gianluca Paniz
Visiting Professor
Department of Implantology at Padova
University of Dental Medicine
Padova, Italy
Panos Papaspyridakos
Assistant Professor of Postgraduate Prosthodontics
Department of Prosthodontics
Tufts University School of Dental Medicine
Boston, MA, USA
Kwang Bum Park
Director
MIR Dental Hospital
Daegu, South Korea
Carlos Parra
Department of Periodontics
Texas A & M University College of Dentistry
Dallas, TX, USA
Lucrezia Paterno Holtzman
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Aruna Ramesh
Diplomate, ABOMR
Associate Professor and Interim Chair
Department of Diagnostic Sciences
Division of Oral and Maxillofacial Radiology
Tufts University School of Dental Medicine
Boston, MA, USA
Tannaz Shapurian
Associate Clinical Professor
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Teresa Chanting Sun
Department of Periodontology
Tufts University School of Dental Medicine
Boston, MA, USA
Rainier A. Urdaneta
Prosthodontist
Private Practice
Implant Dentistry Centre
Jamaica Plain, MA, USA
Jeff Chin-Wei Wang
Clinical Assistant Professor
Department of Periodontics and Oral Medicine
University of Michigan School of Dentistry
Ann Arbor, MI, USA
Hans-Peter Weber
Professor
Department of Prosthodontics
Tufts University School of Dental Medicine
Boston, MA, USA
Wichaya Wisitrasameewong
Post-Doctoral Fellow
Division of Periodontology
Department of Oral Medicine, Infection and Immunity Harvard School of Dental Medicine
Boston, MA, USA
We are excited to present 49 Clinical Cases in Implant Dentistry. The cases have been authored by invited clinicians and residents that have diverse training and different backgrounds. Each case presents a real patient scenario with the appropriate clinical and radiographic information. The cases convey the steps involved with diagnosis, treatment planning and treatment covering both the surgical and restorative aspects.
Although each chapter is presented under certain thematic headings, we realize that many aspects of each case and each discussion cross over to areas covered in other chapters/cases. There is also redundancy in topics discussed/presented since each author was presenting their own cases with self-generated study questions/discussions. It is this diversity of clinical viewpoints and reviews of the literature that we believe will give our readers the best overview of the multiple challenges, topics and reviews of the literature presented by the cases.
Each case and the discussions and literature presented should be treated and appreciated with this in mind. We hope that you use the cases and information supplied to add to your clinical expertise in the areas presented, and as a review for potential clinical and board exams!
Hans-Peter Weber
Nadeem Karimbux
A special thanks to my spouse and children (Hema Ramachandran and Naavin and Tarin Karimbux) for putting up with all my “lap-top” time processing chapters and manuscripts as a part of my academic pursuits.
NK
My gratitude goes to my spouse Cheryl for supporting me throughout my career and generously accepting the fact that projects like this book are not possible without spending personal time at home on them.
HPW
An acknowledgment is extended to all the residents at Harvard and Tufts University Schools of Dental Medicine. We learn from you every day as you grow in your pursuit of clinical knowledge and skills. A special thanks to the faculty for their commitment to our students and for contributing to the chapters in this book.
NK, HPW
The patient when presented was a well-controlled type II diabetic. His last glycated hemoglobin was 6.2, measured a month before his initial visit. He was taking metformin 1000 mg per day. Other than diabetes, the patient did not present with any other relevant medication condition, allergies, or any untoward incidents during his previous dental visits.
The patient did not smoke but he reported that he was a social consumer of alcohol.
No significant findings were noted. The patient had no masses or swelling, and the temporomandibular joint was within normal limits. No facial asymmetry was noted, and lymph nodes assessment yielded normal results.
There were no occlusal discrepancies or interferences noted (Figures 2, 3, and 4).
A full mouth radiographic series was ordered. (See Figure 6 for patient’s periapical radiograph of the area of interest before extraction of #30 and after extraction and ridge preservation.) The postextraction radiograph revealed radiographic bone fill of the #30 socket. The crestal bone level was well maintained. Normal bone levels in the adjacent teeth were noted. The inferior alveolar canal was not visible in any of the three radiographs.
American Academy of Periodontology diagnosis of plaque-induced gingivitis with acquired mucogingival deformities and conditions on edentulous ridges was made.
The treatment plan for this patient consisted of disease control therapy that included oral prophylaxis and oral hygiene instructions to address gingival inflammation. This was followed by implant placement. After an adequate time for osseointegration (4 months), the implant was restored.
The patient when presented to our clinic had already lost tooth #30, which had been extracted 5 months previously. The healing at the extraction site was found to be satisfactory. Systemically, the patient was a diabetic but with good glycemic control and was a nonsmoker. Periodontal examination revealed healthy periodontium with localized areas of mild gingivitis. His part dental history revealed that he was a compliant patient and was on a regular dental maintenance schedule. Occlusal analysis revealed no occlusal disharmonies. These factors together made him a good candidate for dental implant therapy.
The site-specific clinical and radiographic evaluation revealed enough bucco-lingual width and mesiodistal and apico-coronal space for both the placement and the restoration of the implant. The inferior alveolar canal was not in the vicinity of the planned implant site. For these reasons, additional imaging analysis such as cone beam computed tomography (CBCT) was not planned. Impressions were taken during this initial visit that were utilized for doing diagnostic wax-up and for making a surgical guide. Extraoral and intraoral clinical photographs were taken during this visit for patient education and communication with the restoring dentist. Once the treatment plan was finalized, the patient was educated about the dental implant and the treatment sequence. This was followed by implant placement on a separate day using a surgical guide and a drilling sequence recommended by the implant manufacturer.
At the time of treatment the patient presented with type II diabetes, controlled with medications (metformin). His last glycated hemoglobin (HbA1c) level was 6.7%, measured a few weeks before his initial exam. His fasting blood sugar was 120 mg/dL in the last physical exam. The patient was also hypertensive, controlled with medications (hydrochlorothiazide, doxazosin methylate, benazepril). In addition, he had hypercholesterolemia that was controlled with medication (simvastatin). Last, he suffered from a knee injury 4 years prior to his initial visit, which resulted in a blood clot formation that traveled to the lungs. The patient had surgery on his knee and has been taking Coumadin since then. The patient’s last international normalized ratio (INR) was 2.3. The patient’s body mass index was 33.9, which put him in the obese category. The patient denied having any known drug allergies.
The patient had no history of smoking or alcohol consumption at the time of treatment.
There was no clinical pathology noted on extraoral examination. The patient had no masses or swelling. The temporomandibular joints were stable, functional, and comfortable. There was no facial asymmetry noted, and his lymph nodes were normal on palpation.
An overjet of 3.5 mm and overbite of 4 mm were noted. Angle’s molar classification could not be determined due to loss of these teeth. Canine classification could only be determined on the left side, which was class II. Signs of secondary occlusal trauma (worn dentition, mobility, fremitus) were also noted. Functional analysis of the occlusion revealed anterior guidance during protrusion and canine guidance during lateral extrusion movements.
A panoramic and a full mouth radiographic series was ordered (Figure 4). Radiographic examination revealed generalized moderate horizontal bone loss. There was also vertical loss of bone noted in the edentulous areas. A cone beam computed tomography scan was also ordered for better evaluation of the edentulous areas. The height of bone between the crestal bone and maxillary right sinus, in the position of the future implant, as indicated by the radiographic stent, was 4.95 mm and the height of bone between the crestal bone and maxillary left sinus was 8 mm. The height of bone between the crestal bone and the inferior alveolar nerve canal was 12 mm bilaterally. The distance from the right mental foramen was 10 mm (Figure 5). The buccal–lingual width seemed adequate in all indicated positions for placement of dental implants.
A round, well-circumscribed radiopacity with well-defined borders was noted in the maxillary right sinus. The lesion occupied a big area of the right maxillary sinus space. Slight sinus membrane thickening was noted in the maxillary left sinus (Figure 5).
A diagnosis of generalized moderate and localized severe chronic periodontitis with mucogingival deformities and conditions around teeth (facial, lingual, and interproximal recession and aberrant frenum), mucogingival deformities and conditions on the edentulous ridges (horizontal and vertical ridge deficiency in all edentulous areas and aberrant frenum), and occlusal trauma (secondary) was made. Additional diagnosis of partial edentulism with Kennedy class I in the maxilla and Kennedy class I (mod 2) in the mandible was made.
Figures 67