Interdisciplinary Implant Prosthetic Rehabilitation in a Patient With Hypertension and Dental Anxiety: A Case Report

Hypertension and dental anxiety can complicate extensive surgical and prosthetic dental treatment, particularly when multiple procedures and prolonged appointments are required.This case report describes the interdisciplinary management of a 59-year-old woman who presented with a compromised maxillary implant and mucosa-supported prosthetic rehabilitation.Clinical and radiographic evaluation demonstrated four existing implants, peri-implant bone loss, gingival inflammation, and additional restorative and endodontic findings requiring comprehensive reassessment.At the initial consultation, the patient was visibly anxious and had a blood pressure of 180/110 mmHg.Elective treatment was deferred, and she was referred for medical evaluation and management of her hypertension and anxiety.Dental anxiety was evaluated through the patient's reported history and clinical presentation rather than a validated assessment instrument.Fifteen days later, after taking her prescribed enalapril, her blood pressure was 129/85 mmHg, and digital records were obtained for provisional treatment planning.Digital visualization was also used to explain the proposed rehabilitation and improve the patient's understanding and confidence before treatment.At a subsequent appointment, her blood pressure was 125/89 mmHg, allowing treatment to proceed.As part of the staged rehabilitation, tooth #8 was extracted, and the site underwent bone grafting.Maxillary sinus augmentation was performed in the region of tooth #3 using autologous platelet-rich fibrin and a collagen membrane, followed by placement of an MIS implant in the #3 region, resulting in a total of five maxillary implants incorporated into the rehabilitation plan.After a six-month healing period, the definitive restorative phase was initiated during a single clinical session lasting approximately four hours.The provisional restoration was removed, scan bodies were used for digital implant impressions, and the restorative procedures for the implant and mucosa-supported zirconia prosthesis extending from the #3 to #10 region, zirconia veneers on teeth #11 and #12, and a three-unit zirconia fixed dental prosthesis extending from #13 to #15 were completed.Three and a half weeks later, the definitive prosthetic restorations were delivered and evaluated for adaptation, occlusion, function, and esthetics.At the threemonth follow-up, the rehabilitation demonstrated a favorable clinical outcome, and the patient remained satisfied with the functional and esthetic results.This case highlights the importance of recognizing markedly elevated blood pressure, coordinating medical management, addressing dental anxiety, and using staged interdisciplinary planning when providing complex implant prosthetic rehabilitation.