Lanza 2017
Lanza 2017
Lanza 2017
Case Report
Multidisciplinary Approach in the Management of a Complex
Case: Implant-Prosthetic Rehabilitation of
a Periodontal Smoking Patient with Partial Edentulism,
Malocclusion, and Aesthetic Diseases
Copyright © 2017 Alessandro Lanza et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Complex periprosthetic cases are considered as challenges by clinicians. Clinical and radiographic parameters should be considered
separately to make the right choice between an endodontically or periodontally compromised treated tooth and implant. Therefore,
in order to decide whether the tooth is safe or not, data that have to be collected are specific parameters of both the patient
and the clinician. In addition, the presence of periodontal, prosthetic, and orthodontic diseases requires patients to be set in
multidisciplinary approach. The aim of this case report is to describe how the multidisciplinary approach could be the best way to
manage difficult cases of implant-prosthetic rehabilitation. How to rehabilitate with fixed prosthesis on natural teeth and dental
implants a smoker patient who presents with active periodontitis, multiple edentulous areas, dental malocclusion, and severe
aesthetic problems was also described.
Figure 21: Lateral right view. develop an efficient treatment plan. Thus, the predictability
of the therapy and its advantages and disadvantages support
the clinician to assess the prognosis. It is extremely important
to make the right choice between an endodontically or peri-
odontally compromised treated tooth and implant. Therefore,
in order to decide whether the tooth is safe or not, data
that have to be collected are probing depth, attachment level,
mobility, inflammatory and hygiene indices, root anatomy,
furcation involvement, and crown-to-root ratio [13, 14], but
not enough. Avila et al. [15] consider six levels of evaluation
to decide whether a tooth can be saved or not; for each level
a number of variables are assigned with the green, yellow,
and red colours to indicate long-term maintenance favorable,
Figure 22: Frontal view.
caution recommended, and long-term survival unfavorable,
respectively; among these variables as well as parameters
related to the specific site, variables relating to systemic con-
rehabilitation due to parafunctions. From a functional and dition, compliance, and expectations of the patient together
esthetic perspective, the objectives were achieved restoring with clinician’s skill can be noted. According to their scores,
good occlusal stability and a pleasant and harmonious smile then a point total was assigned, expression of a clinical indi-
line (Figures 21, 22, and 23). Periodic nonsurgical periodon- cation which may be recommended/considered extraction or
tal therapy and accuracy of prosthetic structures helped maintenance of the treated tooth [15]. Evaluation of these
maintain the amount of bone fairly stable over time. The parameters enables the clinician to determine the role that
radiographic check at one year (Figure 24) demonstrated every single element can play in the prosthetic rehabilitation
no bone loss around implants and teeth compared to the of the case [13–15]. According to above-mentioned studies,
starting condition (Figure 2). The multidisciplinary approach the decision to save a tooth or not is determined by specific
[11] together with the control of local risk factors such as parameters of both the patient and the clinicians. In the
plaque and smoke [12] has allowed obtaining an aesthetic and current case, molars in the second and third quadrant have
functional integration of the final rehabilitation on natural a negative prognosis due to severe periodontal destruction,
teeth and implants. so the extraction of them was preferred reducing a chewing
up to 2.5 to 3.6. On the other hand, it can be stated
3. Discussion that periodontally compromised patients can benefit from
prostheses on implants, provided that periodontitis has been
Complex periprosthetic cases are considered as challenges by treated and supervised, although the risk of peri-implantitis
clinicians. A proper diagnostic setup is the starting point to seems to be higher [4, 5]. Only through a starting periodontal
6 Case Reports in Dentistry
therapy to eliminate etiological factors and regular follow- on Periodontology,” Journal of Clinical Periodontology, vol. 38,
up to maintain the stability of periodontally conditions, supplement 11, pp. 178–181, 2011.
the implant therapy could be considered predictable in [7] D. A. Garber and U. C. Belser, “Restoration-driven implant
periodontal patient. In addition, the presence of orthodontic placement with restoration-generated site development,” Com-
problems and bad habits that could concern these patients pendium of Continuing Education in Dentistry, vol. 16, no. 8, pp.
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[8] D. P. Tarnow, S. C. Cho, and S. S. Wallace, “The effect of inter-
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4. Conclusions Journal of Periodontology, vol. 71, no. 4, pp. 546–549, 2000.
The multidisciplinary approach is the best way to manage [9] N. Elian, M. Bloom, M. Dard, S.-C. Cho, R. D. Trushkowsky,
and D. Tarnow, “Effect of interimplant distance (2 and 3 mm)
difficult cases of implant-prosthetic rehabilitation. A proper
on the height of interimplant bone crest: a histomorphometric
diagnostic setup is the starting point to develop an efficient evaluation,” Journal of Periodontology, vol. 82, no. 12, pp. 1749–
treatment plan; however, the predictability of the therapy 1756, 2011.
depends on different factors relating to patient and clinicians.
[10] U. Brägger, S. Aeschlimann, W. Bürgin, C. H. F. Hämmerle, and
Therefore, periodontal and prosthetic control of the case N. P. Lang, “Biological and technical complications and failures
and good patient compliance are the key factors in order to with fixed partial dentures (FPD) on implants and teeth after
increase the predictability of the multidisciplinary approach four to five years of function,” Clinical Oral Implants Research,
in advanced case of implant-prosthetic rehabilitation. vol. 12, no. 1, pp. 26–34, 2001.
[11] M. K. Goyal, S. Goyal, V. Hegde, D. Balkrishana, and A. I.
Conflicts of Interest Narayana, “Recreating an esthetically and functionally accept-
able dentition: a multidisciplinary approach,” The International
The authors declare that there are no conflicts of interest Journal of Periodontics & Restorative Dentistry, vol. 33, no. 4, pp.
regarding the publication of this paper. 527–532, 2013.
[12] L. J. A. Heitz-Mayfield, “Peri-implant diseases: diagnosis and
risk indicators,” Journal of Clinical Periodontology, vol. 35,
Acknowledgments supplement 8, pp. 292–304, 2008.
The authors thank the Head of the “Estetica Dentale” Labo- [13] M. S. Tonetti, P. Steffen, V. Muller-Campanile, J. Suvan, and N.
P. Lang, “Initial extractions and tooth loss during supportive
ratory, Mr. U. Castaldo, for the realization of the prosthesis
care in a periodontal population seeking comprehensive care,”
and Professor Alessandro Lanza, Dr. Fabio Scognamiglio,
Journal of Clinical Periodontology, vol. 27, no. 11, pp. 824–831,
and Professor Gennaro Minervini for the presented poster at 2000.
XXIII International Congress of AIOP.
[14] L. Landi, S. Piccinelli, R. Raia, F. Marinotti, and P. F. Mani-
cone, “Perioprosthetic and implant-supported rehabilitation of
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