On Wednesday, October 4, 2017, Mr. Thomas Santacroce DMD 18 presented the first Grand Rounds Presentation of the academic year in classroom G-301 at the Henry M. Goldman School of Dental Medicine. The event was presented by Dean Hutter and Drs. Celeste Kong, Carl McManama, and Cataldo Leone, with Dr. McManama moderating the presentation.
Mr. Santacroce completed his externship rotation at Boston Medical Center, in the Center’s Yawkey Building, where he worked with Dr. Husam Batal and Dr. Eyad Haidar. For his presentation, Mr. Santacroce presented a case that called for multi-staged implant placement at #8 and #9 sites. The 31-year-old male patient presented with significant facial trauma and an unstable alveolar bone following a serious bicycle accident. The accident had resulted in a complete root fracture of tooth #9 and luxation trauma to tooth #8. Immediately following the accident, the patient had some restorative work done in the form of a composite repair of an incisal fracture of tooth #8 and an essix for #9. While this was good temporary work, the composite was beginning to stain and the tooth was not going to survive long term.
The patient’s oral health history was excellent, as he had superior oral hygiene, only minor restorative treatments in his youth, and no report of adverse experiences. While the patient had a full-time job and financial stability, his main hurdle in treatment was his limited disposable income for the implants. In crafting the treatment plan, Mr. Santacroce and the team at BMC had to consider his need for good esthetics for his workplace and self-esteem, and also his limited financial resources.
They began with a consult at GSDM with the Department of Oral & Maxillofacial Surgery for a CT, full evaluation, FMX, and CBCT. Next, tooth #9 was extracted, with an implant immediately placed (a Nobel Active 4.3 x 13mm). A non-functional temporary was also immediately inserted and tooth #8 was prepared for essix. Following this procedure, the team decided to wait four months for healing and for financial ease for the patient. The next stage called for the extraction of tooth #8, guided bone regeneration with PRGF, and another five-month waiting period.
Stage three was comprised of a second CBCT, uncovering of the graft site, placing the implant in site #8, and a subepithelial CTG. In this same time-period, a cantilever bridge was inserted as a temporary, and the milled PMMA with one engaging ti-base with a metallic strut for support.
Final impressions were then taken of the patient and sent to the lab to get the final crowns for placement. After some issues with the crowns themselves, their final cementation took place on August 7, 2017. The ti-bases were steam-cleaned, the crowns were aligned on the cast to check their final fit, they were cemented in place with Multilink Hybrid Abutment, and the Zr-to-Ti base interface was polished.
Following his presentation, Mr. Santacroce fielded questions from many faculty members and students. Dean Hutter then presented Mr. Santacroce with a certificate for his Grand Rounds Presentation and congratulated him on a job well done.