Dental Seminar Training Subperiosteal Implant Reconstruction Testing Assessment Evaluation Services
Michigan Dental Seminars

Ara Nazarian, DDS
Advanced Teeth Attachment
1857 East Big Beaver Rd
Michigan Dental Center
Troy MI 48083
(248) 457-0500

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Creative Solutions for Dental Implant Alternatives

Bone Graft Embeding

A 50 something aged female presented in our office a few months ago requesting help to develop a solution for regaining the use of an upper denture that would be functional for her.

Meth Mouth Xerostomia
Serious Porosity Issues
A long time denture wearer, her maxillary ridge would no longer support any type of denture prosthetic.

Due to an unusally high degree of bone porosity she was declared a non-candidate for any type of dental implant solution for fear of predictable treatment failure.

She had consulted with numerous general dentists, implantolgists and specialists throughout Michigan.

Scans and More Scans

The patient provided a number of scans and Panorex's that confirmed the lack of dense bone tissue in the upper jaw and bony ridge, in particular.

Meth Mouth Xerostomia
Investigative Scan
An addtional scan was obtained to "map" her overall bone structure to investigate opportunities for a subperiosteal frame that could be encased, or embedded in newly osseointegrated bone.

It was determined that the patient had sufficient bone porosity and overall tissue health that would support a unique grafting protocol for embedding a custom titanium framework that would be initally secured to deep levels of dense bone tissue while providing a healthful platform for bone tissue regeneration that would completely encase the prosthetic attachment framework.

CAD/CAM Stone Modeling

Meth Mouth Xerostomia
Stone Model Representation
It is critical to assure secure attachment along with overcoming the historical, common "technical event" of a pocket developing deep within graft material or other oral tissues that could lend toward bacteria accumulation would be eliminated in total.

Of the relative few dental labs with CTscan resources available for fabricating a subperiosteal framework, we were assured of an abolute fit, accommodating the topography of the bone structure the frame would be placed on.

Our scans were sent to Dutton Dental Concepts, Inc., located in Ohio, for the final fabrication and millwork.

CTscan Based Titanium Milling

CAD/CAM Subperiosteal
CAD/CAM Generated Framework
Hydroxyappetite Coated Titanium
The adjacent picture shows the custom milled framework that follows every contour and angulation of the patient's current "jawbone status".

Attachment points were created along the frame that provided the ability to physically attach the frame, via titanium screws, to known high density areas of the patient's bone sructure.

All aspects of the framework that would be embedded (or encased in newly regenerated bone tissue) are coated with the osseointegrative materials used on today's advanced, traditional implants.

Extended Perioflap Surgery

A perioflap was created in an extended fashion that not only exposed the bony ridge... but exposed the base of the bony ridge where the titanium framework would be mounted.

Troy Perio Flap
Exposed Ridge and Base

Assuring Framework to Bone Contact

The frame is titanium with all imbedable surfaces coated with Hydroxyappetite, a popular material used on many traditional dental implants.

The frame was physically attached with torqued titanium screws, providing the required assurance that no gaps existed between the frame and the patient's bone structure.

Bone Graft Formulation and Placement

Submerged in bone
Bone Graft Placement
A specific formulation of bone graft material was made to assure good viscosity yet would pack or clump tightly.

The graft material was required to flow into certain critical areas during the packing procedure, as needed, while being stable enough to remain where placed.

Because this particular treatment focused on the upper jaw only, special steps were taken to assure no gravitational effects would occur where the bone graft material would shift or fall out before final suturing.

Meticulous Packing: Attention to Detail

Guided Tissue Regeneration (GTR) membranes were used as needed, for optimizing subperiosteal grafting success. Special suturing methods were employed to prevent any possibility of seepage which could create the potential of graft product shifting.

Creating solid bone regeneration
Hydroxyappetite Coating 100% Embedded

Repositioning the Periodontal Flap

The soft tissues were returned to their original positions and sutured in a progressive fashion to assure the packed graft product did not shift while treatment continued. The last area for final packing was the anterior aspect of the arch.

During the final suturing small amounts of graft product were added, where needed, to maintain a predetermined degree of overall plumpness of gingival tissue throughout the entire arch of the augmented bony ridge.

Solid bone imbedding
Confirmation of Successful Placement

Post Treatment X-ray Confirmation

The adjacent x-ray photo confirms idealized placement of the framework.

Despite the existence of more irregularities near the patient's left sinus cavity, the custom milling created a framework that maintains an idealized bite plane that will assure good bite dynamics with her new prosthetic teeth.

One Appointment Teeth Replacement

Immediately following surgery the patient was provided an immediate denture product that was pre-configured with "hader-bar-like" clips mounted on the underside of the prosthetic.

Healing Success
Postoperative Healed Implant Frame
She went home with attractive, functional teeth that occluded well with her lower jaw. To promote overall tissue healing she was recommended for a soft food diet for several weeks.

Oral health care products were provided to the patient, along with instructions, to promote healthful removal of food debris from the sutured areas.

Gingival sutures were removed after a few weeks to accelerate continued healthful healing. For this patient, full osseointegration was completed in about 4 months.

Subperiosteal - Embedded Implant Device

Healing Success
Denture Attachment Clip Placement
The embedding products, procedures and protocols selected by our patient was the only treatment option remaining for her.

In her case, she did not have the minimum requirements of bone health involving quantity, quality, depth and width needed for traditional implant placements.

The efficient distribution of biting forces throughout the entire embedded framework will serve well for maintaining the stimulation needed to maintain overall bone health.

She now enjoys the ability to eat anything she desires without fear of her denture slipping, rocking, clicking or being painful.

Healing Success
Aesthetic - Functional Balance
Being able to laugh freely and smile broadly is as spontaneous as it once was. Her ability to make normal speech sounds are incident free.

Patient Comments

I have had dentures for over 30 years and have had a couple relinings and a couple of new dentures in this period of time. The last time I went for a relining it was told that nothing could be done except to have a new denture made. Because of much bone loss and many different dentists and no hope in sight, I was referred to you.

Because of the bone loss, you gave me only one solution that might help me. You told me of a thing called Subperiosteal Implants. Your information and professional attitude educated me in what you could do for me and gave me hope.

You understood what I was looking for and needed, yet knowing that you desired that as much as I. Your encouragement of success and the care you gave me carried me through the process.

I thank God and you for giving me a new wonderful smile. I thank you once again for such care you gave me. I love my new smile.

K.B. in Royal Oak

Questions and Details

Dr. Nazarian can be most easily contacted via our on-line email Contact Form. He will respond to you directly with the answers you seek to any questions about the material on this page.

Michigan Dental Seminars
Ara Nazarian, DDS Seminar Leader
1857 East Big Beaver Road
Troy MI 48083
(248) 457-0500 - Fax: (248) 457-0501

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