Evaluation

A 53-year-old male diagnosed with OI type I was referred to our clinic for extraction of the remaining maxillary teeth and evaluation for full arch immediate load hybrid prosthesis. His clinical history included osteogenesis type 1, bipolar disorder, alopecia, and hypothyroidism. The patient presented with normal stature, measuring 170.18 cm and weighing 81.65 kg with characteristic blue sclerae of OI type I (Fig. 1). Throughout his life, he has had multiple orthopedic fractures due to his OI. At the time of surgery, he was on Lamictal, Xarelto, Synthroid, lisinopril, and hydrochlorothiazide.

Extraoral, TMJ, intraoral soft tissue, and lymph node examinations produced no abnormal findings. An examination of the dentition revealed the maxillary teeth were in poor repair with a fixed bridge extending from site number 2 to site number 5 with site number 3 serving as the pontic abutment. Sites number 8, number 9, number 10, and number 11 have periodontal involvement as well as recurrent decay. He was edentulous on the posterior left maxillary arch. His lower dentition consisted of sites number 19 through number 27 with number 28 being edentulous and number 29 having a root fracture (Fig. 2). The upper jaw had good ridge width with reproducible centric relation and centric occlusion. The patient was otherwise healthy apart from medical issues directly related to his OI.

Due to his significant gag reflex, he was unable to wear a removable prosthesis. Lengthy conversations regarding implant therapy and implant options were reviewed as well as risks with his OI. Options presented included no treatment, placement of fixtures to support a removable prosthesis, placement of fixtures to support a fixed hybrid, and placement of axial implants for fixed denture prosthesis. He elected for a fixed denture prosthesis. Our patient was apprehensive towards having full edentulation and implant placement completed all at once and decided to have the implants placed in stages (Table 2).