Rehabilitation of a young patient with a severely degraded dentition
Dr. Ana Ferro
“The high implant and prosthetic survival rates of the All-on-4® treatment concept makes it a safe and predictable surgical protocol from both the clinician‘s and the patient‘s point of view. Clinicians should adopt this treatment concept in their daily practice to avoid demanding and time-consuming additional surgeries.”
Patient: male, 23 years old, healthy, smoker
Clinical situation: poor oral health. Severe deterioration in the maxilla, and of the molar teeth in the mandible. Remaining teeth show no sign of periodontal loss and mobility.
Surgical solution: Maxilla: All-on-4® treatment concept with NobelParallel CC implants. Mandible: Extraction of all molar teeth. Implant surgery 6 months after extraction: tooth 3.6 and 4.6
Restorative solution: Provisional: Malo clinic all-acrylic provisional bridge with Temporary Snap Coping Multi-unit Plus. Final: NobelProcera implant bridge, Kulzer Pala Premium teeth and artificial gingiva
Surgery date: October 2017
Total treatment time: Immediate delivery of all-acrylic provisional bridge, 10-day post-operative control
Case courtesy of Dr. Ana Ferro.
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Initial clinical situation
The orthopantomogram (OPG) of the maxilla shows a poor prognosis and severe oral impairment.
The large granulomas associated with most of the upper teeth will leave extended bone defects in the maxilla. In the mandible, a good preservation of dentition is visible from pre-molar to pre-molar.
Initial clinical situation
Severe tooth decay and absence of prosthetic space, especially in the posterior sectors (left).
Bite evaluation (right).
Bone reduction was necessary to make prosthetic space for the NobelProcera bar and the bridge with false gingiva to ultimately enhance the functional and esthetic results (left).
The flap was elevated so the anatomical references, nasal fossa and sinus external wall, were visible. The All-on-4 Guide was used to insert the distal implants in the arch with an accurate angle (center).
The Multi-unit Aligning Instrument used to identify the angulation of the Multi-unit Abutment and simplifies the identification of screw hole trajectory avoiding facially protruding screws (right).
OPG showing an optimized implant distribution, with all abutments and Healing Caps in position. Due to the medium density of bone, bicortical anchorage was not necessary.
Titanium Healing Caps in position over the abutments to shape the soft- tissue. The 5 mm high Healing Caps were used because of the patient’s high soft-tissue volume (left).
Frontal view of the all-acrylic provisional bridge (right).
Maxilla healing 10-day post-operative. Abutments are cleaned and checked for loosening (left).