1. ASSC/Center for Advance Dental Studies Treatment Planning Case – December 4, 2012

2. Patient 39 year old female Concerned about – – Missing teeth – Spaced out lower teeth – Dissatisfied with upper removable partial Poor retention Clicks when in function – Dissatisfied with “flatness of mid-face”

3. Medical History No Significant Medical History Not On Any Medications No Allergies

19. Diagnosis Dental – Missing teeth #’s 2,4-14,16,19,30,32 – Caries #’s 18,29,31 – Overhanging restorations 3, 15,20 – Generalized mild marginal bone loss 1 – 2mm – Apical periodontitis # 29 – Inadequate / Failing restorations Teeth #’s 1,3,15,20, 31

20. Diagnosis Skeletal – Maxillary hypoplasia A/P, Transverse, Vertical – Severe resorption of maxillary alveolus – Enlarged maxillary sinuses

21. Treatment Planning Exercises Assume that there is no financial restrictions From a removable prosthetic standpoint what are the problems and restrictions that this patient presents? How would one best design a removable partial or full denture with this skeletal relationship without using implants? – What are the limitations? – What is the long term prognosis?

22. Treatment Planning Exercises How can dental implants be used in this patient to facilitate a partial denture? How can implants be used to facilitate a removable full denture? How can implants be used to develop a full fixed restoration?

23. Treatment Planning Exercises What are the limits and restrictions that the patient has regarding her present dentition and skeletal relationship that limits or prevents the previous treatment modalities? Can these relationships be managed to allow for a workable, stable prosthetic solution, establishing acceptable occlusal and functional relationship? How?

24. Acknowledgement I understand that this is a very complex case, and the actual treatment of it is not so important (although we will review it) What I am looking for in our discussion is to develop understandings on how we deal with a challenging skeletal relationship and the thought process in removal prosthetic design as well as utilization of modalities such as implants if possible to facilitate a stable result.

25. Teams We will divide the group in to three teams to discuss these options. Again, regardless of the option, there are no monetary or medical restrictions.