Immediate Load in Bruxist, Diabetic and Hypertense Patient

Clinical case by Dr Miguel De Maeztu, MD, DDS, PhD and Dr Irune Ucin, DDS

Authors

Dr Miguel De Maeztu, MD, DDS, PhD Private practice in Tolosa, Spain Dr Irune Ucin, DDS Private practice in Tolosa, Spain

Patient

Male, 58 years old, type II diabetes and HTA, controled; complete edentulism in maxilla and 10 remaining teeth in the mandible in terminal periodontal state with grade IV mobility. Complete removable upper prosthesis bearer. Bruxomaniac.

Treatment Planning

Present teeth extraction (37,35,34,33,31,41,43,44,45 and 47). Wait 2 months until healing of shoft tissues. Placement of 6 upper Zimmer SPB implants for upper overdenture and 6 lower Zimmer SPB implants for fixe protheses.

Problem

Three months after de placement of the implants, when taking the impressions, the implant placed in position 36 fails. In the same action, the implant is retired and another one is placed in position 35, with a ISQ value= 74. (Figures 1,2,3)

Solution

Given the ISQ value of the implant placed immediately (ISQ:74) and the ISQ values of the rest of lower implants (67, 75, 71, 67 and 65), the implant is included in the lower impression, the scheduled plan is carried out and the definitive prosthesis is placed after 7 days. (Figure 4)

Comments

The possibility of using Osstell and the obtained ISQ value at the moment of the placement allowed us to include the implant in the impression taking and to subject it to immediate load for a long prosthesis (37 to 47), in a risky patient, without delaying the end of the treatment, nor making it more expensive with provisionals.