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Sub-Periosteal Treatment Choice


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Subperiosteal Implant Solution

Treatment Choice for Deficient Jawbone

Patients who have been denture wearers for an extended time can experience bone loss in the upper or lower jaws just from wear and tear issues.

At Risk - Poor Porosity
for standard implants
Poor oral health conditions, untreated for too long, can also lead to conditions where insufficient bone exists for denture use and the use of traditional or mini implant devices.

Maxillary bone density (upper jaw) characteristics are significantly different from the lower jaw in most individuals. Upper jaw bone tends to be more porous and when failing, due either to wear and tear or disease, loses integrity quickly which can prevent the use of implant devices for some individuals.

Chin block and ramus grafts, which usually involve grafting blocks of bone onto the remaining boney ridge, may also be in inefficient due, again, to porosity limitations and poor blood supply.

Subperiosteal Implants

Dentists, periodontists and oral surgeons who have access to and, perhaps more importantly, experience in subperiosteal surgeries, almost routinely offer this implant device as a viable solution for patients who have been told no options remain for using common dentures and or traditional implants due to inadequate bone structure.

Subperiosteal treatment solutions were introduced nearly 25 years ago. Patients not wanting to face the prospect of being permanently toothless on either or both arches can be recommended for this treatment option for recreating solid dental function and good cosmetics.

Stone Model Framework Subperiosteal Implant Baltimore
General Example
Vitallium Framework Molded to Boney Ridge

Custom Formed Framework

Vitallium, a chrome - cobalt alloy, is used to construct the framework. Molds of the upper jaw bone are created by exposing the bone and taking an impression or through a Catscan 3 Dimensional xray. The implant posts for the patient pictured here are integrated into the framework.

The adjacent photo is used for illustration only.... demonstrating how the framework is molded over a stone model created from the impression molds taken of the maxillary ridge.

Notice the snug fit around the entire ridge. The implant posts sit on the very top of the bone.

Grafting products are added to the surgery site as needed to start rebuilding bone, soft tissue and connective tissues that will full integrate the Vitallium alloy infrastructure into the what will become a renewed or rehabilitated maxillary ridge.

Four (4) Implants Subperiosteal Implant Photo Maryland
4 Implant Post Configuration
Custom Vitallium Framework
The next adjacent photo is the actual subperiosteal device that was used with our patient.

Technical data generated from his diagnostic studies and xrays indicated a 4 implant post device as being the ideal configuration for distributing the physical and biting forces across the entire jaw.

Implant Posts Centered on Boney Ridge

As can be seen from the two framework photos, the patient's upper arch is wider yet the framework is molded tightly around his existing bone to provide a stable, snug fit.

The next photo shows the gingiva pulled away from the actual boney ridge, with the implant framework in place. The implant posts are firmly centered on the bone.

Subperiosteal surgery Photo Maryland
Surgical Placement
Grafting material is packed around the entire framework and in locations where bone augmentation is needed the most.

Health Considerations for Healing

Maintaining healthy blood supply in the surgery areas is an important key element for healing to take place normally. Cigarette smokers should or must cease smoking if healing and tissue regeneration is to be optimized.

Patients who are diabetic may have special medical considerations, depending upon their diabetes treatment histories.

Healthy Surgery Example

The last photo, taken several weeks post operatively, shows good progress in gingival tissue healing.

Subperiosteal bone tissue grafts Baltimore
Surgical Placement
The width of the maxillary ridge has been widended significantly. As healing and osseointegration continues, bone graft material and connective fibers will further secure the attachment of the Vitallium framework to the jawbone.

Restorative Planning: Choices and Options

The process of deciding which teeth replacement options is usually underway at this point. Assessments for recreating a normalized bite height, or vertical dimension have been made.

Cosmetic options provide the patient the opportunity to select sizing, coloration, shading, choice of acrylic versus porcelain teeth and styling the smile line, the LVI Rule of Golden Proportions that uses a mathematical model for creating the perfect smile.

Edward Leventhal, DDS
Baltimore Cosmetic Implant Dentistry
8860 Belair Road
Baltimore, MD 21236
(410) 256-7300

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