Case Series

Case Description –28 years old / Male Patient had a RTA where he got hit on the left side of the face. He sustained in injury on the left eye and cheek bone which resulted in the change of his facial look.

Patient was treated in the hospital care. On analysis of the CT scan as well as the clinical condition, he was advised to undergone surgery for the same. There was a fracture which led to this depression on the left side of the face involving the eye also. He was told that the fracture bone will be reduced and fixation will be done in order to treat injured region.

Patient agreed upon the advised and he underwent surgery under GA. Post-Surgery photos show the change in the left side of the face i.e. eye and cheek bone region.

Case Description – 26 years old / Male Patient had a RTA where he got hit on the forehead region and nose. He sustained injury on the front of the head along with twisting of the nasal bone due to bony injury. This resulted in the facial deformity which was more obvious in nature. He observed this change 3 days after the injury.

Patient came for the consultation asking to address the issue concerned with his look and also he wanted to get the deformity corrected at once. On analysis of the CT scan as well as clinical condition that existed, he was advised to undergone surgery for the same.

There was a fracture which led to this depression of the forehead bone and also there was displacement of the nasal bone towards the left side. He underwent surgical procedure which involved reduction of the fracture bone and fixation.

Patient agreed upon the advised and he underwent surgery under GA. Post-Surgery photos show the correction done and outcome noticeable in the upper third of the face.

Case Description – 34 years old / Male Patient had loss of the upper and lower front teeth due to RTA. He had associated facial injuries and subsequently got treated in the hospital set up for the same. Post recovery he wanted his missing teeth to be replaced. He was advised to undergo Dental Implant Rehabilitation for the missing teeth in the front tooth region.

As per clinical scenario and in order to comprehensively address the issue with permanent solution, Noble Active Dental Implants was used in order to replace the missing teeth. He underwent treatment for 6 months and finally he got back to his pre injury status.

He has been on follow up for 2 years with satisfactory clinical and radiological condition pertaining to his Dental Implant Treatment.

Case Description – 26 years old / Male Patient had concerns regarding the broken upper front two teeth. History revealed that he had habit of biting on the upper tooth region since childhood. His main issue was also about the spacing between the upper front two teeth. On clinical assessment he had issue with the teeth coming into contact from the lower jaw - front tooth region which was traumatic in nature.

In order to give a good cosmetic outcome as per his expectation and also taking into account about the clinical scenario, he was advised for Full Ceramic Crowns for the Upper Front Teeth with the planning involved in order to close the space between the teeth. Ceramic Crowns – Individual, E Max Crowns was used for the Smile Makeover.

Patient was pleased with the outcome and was convinced that treatment ended up in delivering the result above his expectation.

Case Description – 25 years/ Female Pt. Engineer by profession. She had met with an accident in Maldives while scuba diving. She had got hit on the upper front tooth region which led to loss of 4 teeth in the upper jaw. She came for the consultation asking for replacing the missing upper front teeth. Previously she had undergone orthodontic treatment for badly aligned teeth when she was 14 years old. On clinical and radiological assessment she was planned for comprehensive treatment plan involving the need for bone grafting the upper front teeth region and further replacement of teeth with Dental implants. She was advised and conveyed the need for the elaborative treatment plan.

In Phase I bone grafting was done in the upper front tooth region and was told to wear a removal denture until the permanent teeth were fixed.

In Phase II Dental Implants were placed in the grafted site of the upper jaw and teeth were replaced with the MALO CONCEPT in Dental Implant Rehabilitation. This concept was used in order to address the cosmetic expectation as well as for the long term prognosis.

Periodic follow up was done at regular interval. Clinical and Radiological Assessment was done. Photos and Radiographs depict the yearly follow up data. Its been 3 years now after rehabilitation and patient is very satisfied that she was able to get back her lost smile.

Case Description –36 years/ Female Pt. She had birth deformity i.e. Cleft Lip Deformity – Incomplete in nature not involving the nose or the roof the mouth. She was treated for that deformity at the age of 4 months old. She came for the consultation asking for some improvement in the alignment of teeth and also about her smile. As she was involved in a lot of social activities and also by her profession career expectation she wanted to hide that deformity as much as possible. On clinical assessment taking in to account the overall status of the dentition as well as deformity of the lips, she was advised to undergo treatment in a phased manner.

In Phase I Fixed Orthodontic Treatment was advised for nearly 1 year in order to get the teeth aligned.

In Phase II Surgical procedure involved i.e. Lip Revision was done under GA as a Day Care Procedure.

Phased manner was adapted in order to maximise the result outcome in this case. Since alignment of the teeth had a very crucial bearing on the Lip Revision Surgery Result, patient was well informed about this. Counselling was done periodically in order to address all her issues. Outcome of the treatment has been depicted here. She was very satisfied to see the change both in the teeth as well as her lip scar.

Case Description –23 years/ Male Pt. Engineer by profession and was planning for his Masters in USA. He had come for a routine dental check-up. He had some issues with the lower left back tooth region which was giving him the discomfort in terms of food lodgement in that area for some time now. He had travel planned to USA with in a next 1 week, before seeing us in our centre. At the same time he wanted to know the status of his wisdom teeth.

Taking into consideration about this travel plan and his stay over there, he wanted to sort out his issue completely. As he was apprehensive in undergoing the treatment there, he asked for the solution w r t wisdom teeth. He had a detailed consultation where in option of surgical removal of all the wisdom teeth under GA or LA. Patient then opted for the removal under LA.

Management was done in our centre where in he was scheduled for removal of all wisdom teeth under LA in an early morning appointment taking into account about the pros and cons of surgical procedure. Surgical duration was about 1 hour and 15 minutes. Intra operative and post-operative care was well managed along with Antibiotics and Analgesics for 5 days with other measures. He recovered well with the comprehensive management for 6 days. He was seen for a check up on the 3rd post-operative day and suture removal was done on 5thpost-operative day.

Case Description –26 years/ Female Pt. She had birth deformity i.e. Cleft Lip Deformity – Complete in nature involving the nose and the roof the mouth. She was treated for this deformity at the age of 6 months - cleft lip surgery and later for cleft palate surgery at 18 months. She came for the consultation asking for some improvement in the nose shape and also about her smile. She had undergone treatment for the alignment of the teeth in the past and lower jaw surgery for the cosmetic disfigurement that was basically due to cleft lip and cleft palate deformity.

On clinical assessment taking in to account the overall status of the dentition as well as deformity of nose and the lips, she was advised to undergo treatment in a phased manner. Knowing the constrains in treating the secondary cleft deformities cases, a realistic goal was planned to improve the cosmetic outlook in this case.

In Phase I Surgical procedure was Open Cleft Rhinoplasty under GA as a Day Care Procedure.

In Phase II Surgical procedure involved i.e. Lip Revision was done under GA as a Day Care Procedure – 1 year after the Cleft Rhinoplasty Surgery.

Phased manner was adapted in order to maximise the result outcome in this case. Patient was well informed about this. Counselling was done periodically in order to address all her issues. Final result gave a lot of satisfaction for the patient at the end of the treatment.

Case Description – 52 years/Male Pt. He had come with the complaint of unable the chew food due to loss of teeth in the Upper back tooth region since 8 years. He had got earlier consultation for the same reason where the option of Removable Partial Denture (RPD) was given. As he wanted a fixed option for the teeth he had not undergone any treatment.

Based on the clinical condition that prevailed and with patient expectation, he was advised to undergo Dental Implant Rehabilitation. As the bone availability was satisfactory in the upper jaw region where he had loss of teeth, the detailed plan was explained to the patient along with time frame for the treatment to be completed. In this case rehabilitation was completed within 5 months.

In Stage I Endosseous Dental Implant Placement was done on both sides of the Upper Back tooth region was done simultaneously in a single appointment using Nobel Active Implant System under LA

In Stage II Prosthodontic Rehabilitation of Upper Jaw – Posterior/ Back Tooth region was done Screw Retained Multi Unit PFM Prosthesis.

He has been on a regular follow up over 1 year now with Implant Maintenance Protocol.

Case Description – 52 years/ Female Pt. She had come with the complaint of unable to chew food due to loss of teeth in the back tooth region since 4 years. She had earlier consultation for the same reason where the option of Complete Denture was given after removal of all the remaining teeth. As she wanted a fixed option for the teeth she had not undergone any treatment until her expectation was addressed. Medical condition revealed she had thyroid problem from past 8 years and was on treatment for the same.

Based on the clinical condition that prevailed and also with the patient expectation, she was advised to complete removal of all the remaining teeth and undergo Full Mouth Dental Implant Rehabilitation. Treatment was phased out over a period of 8 months.

In Stage I Total Extraction of Upper Jaw and Lower Jaw Teeth was done under LA. Healing period of 2 months was given where in interim Complete Denture was given until she received her fixed prosthesis through Dental Implant Rehabilitation

In Stage II Surgical Dental Implant Placement in the upper jaw was done initially. Later post one week, Dental Implant were placed in the lower jaw under LA.

In Stage III Prosthodontic Rehabilitation of both jaws was done using Hybrid Prosthesis – Cement / Screw Retained.

She has been on a regular follow up every 6 months now with Implant Maintenance Protocol.

Case Description – 67 years/ Female Pt. She had come for the replacement of her old ¬denture. She had been a denture wearer for past 10 years. She had a good knowledge regarding the Dental Implants for rehabilitation and so she asked whether it was feasible in her case. On clinical and radiological assessment which included CBCT along with surgical stent planning for the dental implant was done as she he add severe loss of the bone in both the jaws.

Reason for surgical stent planning was to address the issue of resorbed upper and lower jaw bones. In this case there was sever resorption was noted and planning was done in best available bone site for dental implant placement. Treatment was carried out in staged manner.

In Stage I Surgical Placement of Endosseous Dental Implants in Mandibular Arch / Lower Jaw under LA. And 1 week later Surgical Placement of Endosseous Dental Implants in Maxillary Arch / Upper Jaw under LA

In Stage II Prosthodontic Rehabilitation of both jaws was done using Hybrid Prosthesis – Cement / Screw Retained

Case Description – 52 year old / Female Patient had issues regarding the spacing in between her teeth in the front tooth region. She also had complaints about her teeth show when she smiles. As per age group, these patients will have issue with the gum diseases. So a comprehensive assessment in that regard was done before the treatment plan was devised. Gum status was good for her age without any co morbid medical conditions.

Multi-Disciplinary Approach was involved in order to meet the expectation of the patient. As patient had spacing between the teeth along with mal alignment of teeth, she underwent Intentional RCT treatment in order to facilitate the Prosthodontic Treatment.

Full Ceramic Individual Crowns for Upper and Lower Front Teeth – 4 teeth in one upper arch and also 4 teeth in lower arch, as we found that issue was in this region. She was restored with E Max Crowns taking into account the upper smile line in order to minimise the gum show. Results was much appreciated by the patient and also it avoided the hindrance that that patient always had when she smiled.

Case Description – 56 years/ Female Pt. She had come with the complaint of unable the chew food due to loss of teeth in the back tooth region since 4 years. She had earlier consulted for the same reason where the option of Complete Denture was given after removal of all the remaining teeth. As she wanted a fixed option for the teeth she had not undergone any treatment until her expectation was addressed. Medical condition revealed she had thyroid problem from past 8 years and was on treatment for the same.

Based on the clinical condition that prevailed and also the patient expectation, she was advised to undergo Full Mouth Dental Implant Rehabilitation. As the bone availability was compromised in the back tooth region, ALL ON 4 Concept of Dental Implant Rehabilitation was planned in her case.

Treatment was phased out over a period of 6 months.

In Stage I Total Extraction of Upper Jaw was done along with Immediate Implant Placement in the jaw using ALL ON 4 Concept.

In Stage II Total Extraction of Lower Jaw was done along with Immediate Implant Placement in the jaw post one week after upper Dental implant placement.

In Stage III Prosthodontic Rehabilitation of both jaws was done using Hybrid Prosthesis – Cement / Screw Retained.

She has been on a regular follow up over 3 years now with Implant Maintenance Protocol.

Case Description – 64 years/Female Pt. She had come with the complaint of unable the chew food due to loss of teeth in the back tooth region since 4 years. She had earlier consultation for the same reason where the option of Complete Denture was given after removal of all the remaining teeth. As she wanted a fixed option for the teeth she had not undergone any treatment. She had a compromised medical conditions which deferred us from planning extensive surgical procedure under GA.

Based on the clinical condition that prevailed and also the patient expectation, she was advised to undergo Dental Implant Rehabilitation. As the bone availability was compromised in the upper jaw region, Concept of Dental Implant Rehabilitation was planned only in lower jaw and Complete Denture Prosthesis was advised for upper jaw.

Treatment was phased out over a period of 6 months.

In Stage I Total Extraction of Lower Jaw along was done along with Immediate Implant Placement under LA

In Stage II Prosthodontic Rehabilitation of lower jaw was done using Hybrid Prosthesis – Screw Retained in the lower arch.

She has been on a regular follow up over 3 years now with Implant Maintenance Protocol.

Case Description – 57 years/ Male Pt. He had complaints regarding the loose teeth in both the jaws. On clinical assessment he had severe gum damage which had led to the mobility of the teeth in both the jaws. Based on the expectation and also the long term prognosis of the teeth rehabilitation, he was advised to undergo Full Mouth Dental Implant Rehabilitation. As he didn’t have any medical co morbidity conditions, he was given the assurance that after Dental Implant Rehabilitation, he will be able to manage it for a longer period of time if timely follow up and Implant Maintenance Protocols are followed over the years.

Full Mouth Dental Implant Rehabilitation was done in three phase planned over 6 months.

In Stage I Total Extraction – complete removal of all the teeth in both the jaws was done under LA. Healing period of 8 weeks was advocated before the placement of Dental Implant

In Stage II Surgical Placement of Endosseous Dental Implants in Mandibular Arch / Lower Jaw under LA. And 1 week later Surgical Placement of Endosseous Dental Implants in Maxillary Arch / Upper Jaw under LA

In Stage III Prosthodontic Rehabilitation of both jaws was done using Hybrid Prosthesis – Cement / Screw Retained

Case Description – – 30 years/Male. He had birth deformity i.e. Right Cleft Lip with Cleft Palate Deformity – complete in nature involving the nose or the roof the mouth. He was treated at that at the age of 6 months for cleft lip deformity and for cleft palate correction at the age of one and half years. He had come for the consultation asking for some improvement in the alignment of teeth and about his nose correction. On clinical assessment taking in to account the overall status of the dentition as well as deformity involving the nose shape, he was advised to undergo treatment in a phased manner. In Phase I Fixed Orthodontic Treatment was advised for nearly 2 years in order to get the teeth aligned.

In Phase II Surgical procedure involved i.e. Cleft Rhinoplasty was done under GA as a Day Care Procedure.

Phased manner was adapted in order to maximise the result outcome in this case. Since alignment of the teeth had a very crucial bearing on the Nose Correction and also on the smile outcome, patient was well informed about this. Counselling was done periodically in order to address all his issues and final result that has depicted here. He was very satisfied to see the change both in the teeth as well as his nose shape.

Case Description – 28 years old / Male Patient had a RTA 4 years back which lead to the fracture of the lower jaw. At that time due to some medical reason complete treatment was not given for his jaw fracture which had led to the bite issue on the fractured site. Patient came for the correction of his bite and wanted his chewing efficiency to be regained on his left side of the lower jaw – the fractured side.

Detail work up was done in this regard and comprehensive plan was discussed with the patient and his relative. Treatment was phased out into 3 stages.

Stage I – Surgery was done in order to reset the fracture site under GA.

Stage II – Fixed Orthodontics Appliance Treatment was done for over 14 months in order to maximise the bite correction.

Stage III – Dental Implant Rehabilitation was done on the Rt Lower Molar Tooth – Endosseous Implant.

Final Result is depicted over here. Patient was completely satisfied with the final bite he could regain by being under the treatment for nearly more than 2 years.

Case Description – 18 years old / Male Patient had loss of the lower front teeth due to accident. He had facial injuries – soft tissue injuries for which treatment was done in the hospital set up. Post recovery he wanted his missing teeth to be replaced. He was advised to undergo Dental Implant Rehabilitation for the missing teeth in the lower front tooth region.

As per clinical condition that existed due to the soft tissue injuries over the lower and also inside the mouth, Dental Implant Rehabilitation – Malo Concept was advised for him. He underwent treatment for 6 months and finally he got back to his pre injury status.

He has been on follow up for 3 years with satisfactory clinical and radiological condition pertaining to his Dental Implant Treatment. The outcome looks satisfactory and also stable.