Case – 2017 Jose A.

Jose Pre-Op

Jose Post-Op

What you will learn

Jose is a patient who has had bad dental experiences in the past.  He currently has a failing upper denture and a lower partial that he does not wear, along with lower natural teeth that are broken down.  Jose is looking for functional stability and increased self-confidence.  He has heard of the “All-on-4” procedure and is interested in this type of treatment because he is not interested in anything removable.  In this video, you will learn how to take a large implant case and treatment plan, sequence, and communicate with your lab and surgeon in order to achieve a predictable functional and esthetic result.

Meeting Goals/Objectives

  • Understand how to treatment plan and sequence a dual arch All-on-4 implant case within the Dawson philosophy.
  • Learn what data-gathering aspects of these cases are crucial to determine in the planning phase and how to communicate this information to your surgeon and laboratory.
  • Learn how occlusal design is extremely important when working with large implant cases, and how this design differs from teeth.
  • Understand the different types of materials available for these All-on-4 cases.
  • Why figuring out tooth position prior to implant placement is CRITICAL in this case, and Why the Dawson “Wizard” approach perfectly prepares you to be able to tackle complex cases like these.

Discussion Points/Questions

  • What are the space requirements needed for a dual arch All-On-4 case and how are these measurements communicated to the surgeon?
  • Why is understanding Jose’s current tooth and denture wear patterns important and how will this affect the surgical planning?
  • What should be considered when opening vertical dimension with natural teeth compared to implants?
  • How are All-on-4 cases sequenced and what are the best ways to handle both the restorative and surgical fees?
  • As the restorative dentist, should you be present at the patient’s surgical appointments? Are there times when the laboratory technician should also be present?
  • What factors go into determining whether an All-on-4 case can be loaded immediately?
  • In Dr. Cranham’s treatment sequence, he had to come up with a “calculated guess” on wear to position the teeth for ideal speech and VDO. How could you remove this “guess work” if you wanted to take less risk with the case?
  • How do you want to design the occlusal scheme of an All-on-4 case? What factors need to be considered?
  • What types of restorative materials could be considered for these types of cases?
  • One thing that is not mentioned in the video is possible airway issues. In this case, what are the signs that there could be an airway issue? What are the possible causes of the airway issue?  What could be done to address an airway issue?

Leader Comments:

  1. There may be some confusion on the measurements related to the overbite/overjet. The measurement should be zero/zero overbite/overjet.  Cranham believes the denture was “floating” when he took the measurements.
  2. The protrusion of the mandible is due to VDP being overclosed. The patient is NOT skeletally Class III.  VDO can be lost when a denture wears.  For every 1 mm the vertical opens, the lower incisor drops back.  So 2-3 mm of opening the VDO will drop the mandible back.
  3. If you want more control than Dr. Cranham used, the dentist could do upper and lower immediate dentures in step one. Let the patient heal, then do upper and lower surgical guides (after verifying tooth positon top and bottom) then place the implants.

CE Codes Breakdown

  • CE Credits Awarded: 3
  • COURSE SUBJECT CODES & HOURS: #690 (1.5L, 1.5P)
    (L) Lecture
    (P) Participation/Discussion/Hands-On

Creation Date: Jan 26, 2017