All-on-4® treatment concept high skilled with NobelParallel™ CC TiUltra™ implant and Multi-unit Abutment Xeal™
Dr. Ana Ferro
Portugal
“In this case, the patient had an extremely atrophic maxilla, with very thin bone in the second quadrant. I decided to choose NobelParallel CC TiUltra implant and Multi-unit Abutment Xeal because of the dehiscence I would have in the posterior tilted implant and the required capacities for an excellent osseointegration and Mucointegration™ process. During implant placement, the hydrophilic capacities of the TiUltra surface and the immediate interaction with the blood were clearly visible. After 10 days, the tissues presented extremely good healing and at 1-year follow-up they look very healthy."
Patient: 53-year-old female
Clinical situation: Failing dentition in the maxilla with partial denture.
Surgical solution: All-on-4® treatment concept, NobelParallel™ CC TiUltra™ implant, Multi-unit Abutment Xeal™.
Restorative solution: Provisional: MALO CLINIC Bridge All-Acrylic Final: MALO CLINIC Acrylic Bridge on NobelProcera® Implant Bar.
Surgery date: February 28, 2019
Total treatment time: 3 months
Tooth position: All
Front, side and profile images of the patient before treatment.
Maxilla (left), mandible (right).
Smile picture - very important to determine if there is a need for bone reduction. In this particular case, the patient shows 1 mm of gum when smiling, which will indicate a need of bone reduction of 3 mm (left).
Maxilla (top right) and mandible (bottom right).
Pre-operative OPG.
DTX™ Studio Implant planning of an All-on-4® High Skilled case with the NobelParallel CC TiUltra RP 4.3x13 mm in the posterior and NP 3.75x13 and NP 3.75x11.5 mm in the anterior.
The surgery starts with extraction of the remnant teeth.
Raising a full-thickness flap with two releasing incisions in the area of the first molars exposing the nasal fossa and the anterior walls of the sinus.
Bone reduction: performed due to a high smile line of 1 mm and the thin crest.
The All-on-4® Guide is placed in the midline and the anterior wall of the sinus is evaluated.
Preparation of osteotomies following the under-preparation protocol. Drilling is performed according to bone density in order to achieve good primary stability.
Placement of NobelParallel CC TiUltra RP 4.3x13 mm implant in the posterior.
Checking the best position for the angulated abutment (left).
A bone mill is used to remove bone at implant‘s head to allow for proper seating of the Multi-unit Abutment Xeal (right).
Placement of 30° Multi-unit Abutment Xeal CC RP 4.5 mm, tightened to 15 Ncm.
Posterior implant placement of NobelParallel CC TiUltra RP 4.3 x 13 mm with 3 mm of dehiscence in palatal area. 30° Multi-unit Abutment Xeal CC RP 4.5 mm.
Anterior implant placement: NobelParallel CC TiUltra NP 3.75 x 11.5 mm (left).
Multi-unit Abutment Xeal CC NP 2.5 mm (right).
Final occlusal view.
Impression taking using silicone putty and placement of healing caps.
Cylinder capture on immediate bridge.
Cylinder capture on immediate bridge with acrylic.
Provisional all-acrylic bridge in place.
Post-surgical OPG.
Suture removal 10 days after surgery.
Final prosthesis in articulator.
Final prosthesis on cast.
Final prosthesis.
10 days after surgery.
Before surgery (left).
10 days after surgery (right).
Patient smile 10 days after surgery (left).
6-month follow-up (right)
1-year follow-up.
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NobelParallel™ Conical ConnectionA simply straightforward implant system.
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All-on-4® treatment conceptLife-changing treatment – a new smile in a day.
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Multi-unit AbutmentKey to the original All-on-4® treatment concept.
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Xeal™ and TiUltra™Welcome to the Mucointegration™ era. Surface chemistry cells can’t resist.
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