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May / June 2018

Advances In Prosthodontics TM

New Findings & Best Practices for Cosmetic & Restorative Dentistry

Do You Have Edentulous Patients With

Insufficient Bone Volume For
Dental Implants?

Do You Have a Patient

With This Situation?
(see photos on right)

Complete Details
on this Full Mouth

Background and
page 2

Treatment Sequence
page 3

Final Result
page 3
Here’s the story of a patient who was referred from
COMPLEX CASES: another dental professional...
Dr. Gilbert & Dr. Goff’s If you have a patient with several missing, broken or severely worn teeth—
Prosthodontic Training & or an edentulous patient who does not have sufficient bone for traditional
Experience Make dental implants—they may be a candidate for oral rehabilitation with the
These Treatments assistance of a Prosthodontist.
More Successful...
page 4 Read more on the next page…
© Sams Media Group, LLC

Do you want another opinion on a complex case? Or to meet and share ideas?

There are many ways we can help each other by working together on complex cases and by sharing
knowledge and experience.

With your reputation for quality dental care, and our experience with restorative treatments, we can work
together on advanced cases and both benefit! 

If you’d like meet to discuss a difficult procedure, or talk on the phone about how we can help each other,
please call or email our office with specific days and times when you are available to talk or meet.

Drs. Gilbert & Goff, Certified Prosthodontists ! Specialists In Complex Care ! 614-946-3556 (cell) ! 1

CASE SUMMARY: Full Mouth Rehabilitation

by Andy Gilbert, DDS, MS, Prosthodontist
Patient “Susan” was referred to our office by a dental professional in the area
who was busy with their patient load, and Susan’s needs were more complex
than they wanted to manage. I met with her at an initial consultation, then
had a follow-up visit to review initial treatment recommendations.

Susan is edentulous and has worn complete maxillary and mandibular

dentures for 19 years. Over the years she has had multiple sets of dentures
made. She expressed that they functioned well in the beginning, but over the
years had become simply intolerable to wear. About 7 years ago, she
attempted the economical solution of having four “mini implants” placed to
help retain her mandibular denture. Unfortunately, all of the “mini implants”
failed and were removed after 4 years. It was a traumatic experience for her
and she had become generally hopeless about the whole situation.

When Susan came to our office, she presented with a severely atrophic
mandible. Additionally, she suffered from a neurological condition that
causes dyskinesia; specifically, a constant involuntary movement of the
mandible. These two factors have made it virtually impossible for her to
function with a mandibular denture, even when applying copious amounts of
denture adhesive. Her existing maxillary denture is not retentive; although,
she claimed it was more tolerable than the mandibular denture. She noted
the overall instability of her dentures caused her painful ulcers on her mucosa
and tongue. She chose to not wear the dentures which has caused her to be on
a liquid diet that has resulted in substantial weight loss.

As prosthodontists, we have experience planning multi-stage treatments

and coordinating with the patient’s general dentist and other specialists. 
 Final photos on next page...
A CBCT was made of her jaws and it was noted that her maxilla lacked
sufficient bone volume for any type of traditional dental implant. Conversely,
her anterior mandible had just enough bone volume and good density for 

four implants.

The treatment plan was for a maxillary upper complete denture and mandibular
fixed detachable implant supported acrylic/titanium prosthesis (hybrid).

Continued on next page...

Do you have a patient in Susan’s situation? Or another complex case?

If you have a question about a case and want another opinion, give our office a call. Or, if there’s
a case that you want to work together on, please fill out and send in the enclosed referral form.

We will take great care of your patient and keep you informed. Dental professionals refer to us as 

The Complex Case Specialists™ because we perform complex cases every day.

Drs. Gilbert & Goff, Certified Prosthodontists ! Specialists In Complex Care ! 614-946-3556 (cell) ! 2

Continued from previous page — Susan’s treatment sequence included:

• It was determined to use four 3.3mm diameter Straumann Roxolid®

implants. While small in size, these implants are a metal alloy composed
of 15% zirconium and 85% titanium which leads to a material with higher
tensile and fatigue strength than just titanium alone. In my opinion, this is
the smallest diameter implant that should be used for a hybrid prosthesis.
• During her healing phase, Susan had her medication changed and this
eliminated her dyskinesia, which greatly helped in the management of her
• After three months of healing, all four of the implants had successfully
osseointegrated and were uncovered.
• For the maxilla, a traditional processed complete denture with proper
border extensions was made.
• For the mandible, a full-arch implant supported hybrid prosthesis made
out of a titanium milled substructure with digitally designed acrylic teeth
was fabricated.
The day the prosthetics were seated was a moving experience. Susan was so
shocked to see her face with teeth. At the follow up appointment, she was
thrilled to show us pictures she
had taken with her
granddaughter. She said her
granddaughter told her:
“Nana, you’ve finally got teeth!”
She has been able to enjoy all
types of solid foods that she
had been missing for so many
years. This was a rewarding case
that our staff will never forget!

We usually refer patients back to their general dentist for

regular hygiene, unless advised otherwise by the referring
office, depending on the patient and treatment.

If you have comments about this treatment, email me

directly at:

How can a Certified Prosthodontist assist you and your dental team?
We specialize in the treatment of complex cases, usually involving several procedures over months of 

care. The next time you see a challenging case, please feel free to call us and we can discuss treatment
planning or help you with any part of the treatment. Our goal is to be a resource for your office by helping
manage difficult and time-consuming procedures, restoring the function and esthetics that the patient
desires, then referring them back to your office for their ongoing care.

Drs. Gilbert & Goff, Certified Prosthodontists ! Specialists In Complex Care ! 614-946-3556 (cell) ! 3

& Goff The Complex Case Specialists TM


Drs. Gilbert & Goff have prosthodontic training from OSU and
private practice experience that make treatments of complex cases
more successful, including the following examples:
• Patients with severely worn/damaged teeth, missing all teeth, or 

with ill-fitting dentures can receive a full arch of natural-looking 

teeth to restore function & esthetics.
• Patients with congenital defects, a chronic condition, or traumatic

injury can receive oral prostheses, which may be a combination of

dental implants, crowns, bridges, or veneers.
• Patients with difficult anterior cases in the esthetic zone can receive

single or multiple dental implants to replace missing teeth, or 

Dr. Andy Gilbert is a Dr. Doug Goff is a
Certified Prosthodontist veneers or crowns to improve the appearance of their smile.
 Certified Prosthodontist
serving the Columbus 
 serving the Columbus 

& Lancaster areas & Chillicothe areas
Personal Message To Fellow 

Dental Practitioners:
“As the referring dentist, you know your patient’s mouth and have key insight into your patient’s needs. 

We want to work with you to provide your patients with the best possible treatment outcomes. 

We will treat your patient in a manner that will reflect well on you and strengthen your relationship 

with your patient. We are here to make you look good! When your patient’s care is completed, 

they are referred back to your office for their ongoing dental care. We are grateful for your 

colleagueship and trust with your patients!”

Why other dental professionals work with a Certified Prosthodontist

Certified Prosthodontists are specialists in implant, esthetic, and reconstructive dentistry.

1. You have a patient requiring complex treatment outside of your typical practice. 

Examples include patients with vertical dimension discrepancies, severely resorbed ridges, 

inadequate interarch space, TMJ, severe bruxism, traumatic tooth loss, or congenital abnormalities.

2. You have a patient with complex needs that may drain your time.

If your patient may require treatment from several specialists, Certified Prosthodontists can help 

because they are trained to appropriately stage and manage complex treatment plans.

3. You have a demanding patient who wants perfect esthetics.

Examples include patients with a high smile line or needing a single tooth replacement in the esthetic 

zone. A Certified Prosthodontist is trained in selecting the best solutions for high-demand patients.

4. You have a question and want to discuss a case with a colleague to ease your mind.

A Certified Prosthodontist can be an excellent resource for you to ask questions because they are 

trained in many types of complicated treatments. For example, you may want to consult a Certified

Prosthodontist for complex implant-supported restorations. They can work with you or complete 

the treatment for you to achieve the best in both function and esthetics.

Drs. Gilbert & Goff, Certified Prosthodontists ! Specialists In Complex Care ! 614-946-3556 (cell) ! 4