Dr. John Nosti got the opportunity to return health and function to a cancer survivor’s mouth.
As the photos indicate, much of William’s tongue was lost and replaced with a graft from his forearm. You can also see significant bone loss in the maxilla and mandible from extractions and subsequent cancer treatment.
The patient came to me with health and function as his main priority. The massive wear on his teeth, in particular on the upper arch along with lack of posterior support, made an implant supported screw retained prosthesis the treatment plan of choice for this patient.
Treatment Planning is Key to Success
We started like I do with all of my rehabs, which is a diagnostic wax up from Gold Dust Dental Lab. I overlayed the upper arch as a “mock up” with bisacryl and prepped #20-28 for all ceramic, e.Max restorations. The overlay in the maxillary arch not only created “teeth” for my patient while he was completing the lower treatment, but this allowed us to evaluate aesthetics, begin planning the surgical and restorative aspects of his case, correct the occlusal planes and vertical dimension. The maxillary mock up was then used to design his immediate denture and set the occlusion for maxillary denture and lower fixed units
We used a temporary denture with gutta percha reservoirs as a radio-opaque stent to plan with the end in mind. By following my treatment planning system, and Smile Design Denture protocol. I was able to communicate ideal placement with my surgeon.
Six Nobel Biocare 4.3mm diameter implants (10-13mm in length) were placed and three months were allowed for osseo-integration before the final prosthesis fabrication began.
The results were spectacular and can be seen simply from the patient’s postoperative smile. Some procedures are incredibly rewarding, not because what I’ve done, but what my patients have accomplished. Bill continues to be an inspiration and I am privileged to have given him his smile back.
Surgical placement of implants completed by Dr. Boris Kalika.