Case #2 By Ankur Aggarwal

Written on 08/04/2017
Masoud Abu Zant

Every once in a while one comes across a case which challenges and changes the very fabric of dentistry and the way teeth can change lives. A 34 year old female came in with a hankerchief over her mouth to hide one of the most severe and advanced form of gingival hyperplasia ever seen by us in our practice. Taken aback at first, we realised that over the past 4 years her gingiva had mysteriously started overgrowing in all directions. There was no history of any disease, drug intake or any other triggering factor. 2 years back some dentist made a futile attempt to fix braces. Clinical examination revealed all teeth had extreme mobility with the upper and lower gingiva touching each other when attempts were made to 'bite normally'. Battery of blood tests were performed with everything being negative.

Well something had to be done so a brave plan was formulated to place implants and hopefully restore them. Dr Anuj Aggarwal Anuj Hanika maxfax surgeon and brother mine proceeded with one quadrant at a time. The gingiva was so thick and edematous and bloody that it took 3 hours per quadrant to cut through the 10 – 15 mm thick gingiva and place implants in whatever bone presented itself. Frankly the number of implants was the least of our concern considering we were absolutely sure that we might have a few implant failures owing to the bizarre nature of the original deformity. After 12 hours of surgery spread over 4 days, the implants were immediately loaded and cementable provisionals were delivered to the patient, who could now smile for the first time without covering her mouth.

After 4 months of uneventful healing, radiographs revealed excellent bone levels in all the implants and satisfactory gingival healing. Considering her previous condition, it was difficult to predict how the gingiva would react to the definitive prosthesis. It was therefore decided to fabricate a cementable layered Zirconia prosthesis made in 3 parts each for upper and the lower jaws. Dr Manish Vishen prosthodontist helped me with the prosthetic part. Indirect impressions were made and casts were poured. Over these casts wax-rims were fabricated for recording jaw relations. Verification jig was used to verify the impressions. At this stage a teeth trial was also done to verify the esthetics (size and shape of the teeth), visibility, phonation and the occlusion. Considering the angulation of the implants and the thickness of gingiva 3 milled Zirconia abutments and 6 milled titanium abutments for the maxilla, and 2 milled titanium and 8 stock abutments for the mandible, were used. A bisque trial was carried out to adjust the occlusal pre-maturities. After the glazing and polishing the final prosthesis was then cemented with a resin cement. Fingers crossed !

By Doctor Ankur Aggarwal