Prosthetically Driven Therapy for a Patient with Systemic Lupus Erythematosus and Common Variable Immunodeficiency: A Case Report.

Dental implant therapy on patients with systemic diseases in conjunction with severely resorbed maxillary and mandibular bone present a challenge for dental rehabilitation. This case report describes the interdisciplinary comprehensive treatment completed on a patient with systemic lupus erythematosus (SLE) and common variable immunodeficiency (CVID). Patients with these systemic conditions present a multifactorial challenge for dental treatment due to advanced carious lesions, missing teeth, lack of adequate bone quality and quantity, in addition to the secondary effects of their medications. The sequence of treatment presented allowed for the necessary case control to ensure successful and predictable reconstruction of the edentulous patient with limited bone available for implant placement. For this patient, a combination of autogenous iliac bone graft, bilateral maxillary sinus lifts with BMP-2, transitional implants, and dental endosseous root form implants were used. Digital dentistry aided in designing the final implant supported fixed restorations. Transitional implants eliminated the need for tissue-borne prostheses, avoiding pressure to the graft and implants. Digital dentistry allowed for prosthetically driven implant placement and a functional and esthetic result. The techniques and staging presented can be used for other patients presenting with similar challenging conditions for implant placement and rehabilitation.