Canada (EN)
CLINICAL CASE
Immediate esthetic and functional rehabilitation of a complete mouth using the All-on-4® treatment concept
Prof. Enrico Agliardi, Italy
Despite adequate bone volume, the case presents several challenges both surgically and prosthetically. From a surgical point of view, the management of an extensive gummy smile has been planned to be corrected through an osteotomy calibrated on extra and intraoral images prior to surgery. Prosthetically speaking the delivery of an immediate rehabilitation of both arches is another challenge faced during the case, due to the lack of reference points and severely compromised esthetics which has been managed through careful planning of the prosthesis manufactured prior to surgery. The key factor for the success was extensive presurgical planning using diagnostic records and photographs.
Patient: 59-year-old, female.
Clinical situation: Failing dentition in the upper and lower jaw due to severe periodontal disease, compromised function.
Surgical solution: Extraction of compromised residual teeth and placement of 4 Nobel Biocare N1™ implants in the maxilla and 4 intraoral implants in the mandible following the All-on-4 surgical protocol.
Restorative solution: Full zirconia implant bridge (Nacera).
Surgery date: March 2021.
Total treatment time: 6 months.
Tooth position: All.
Initial clinical situation
Preoperative X-ray. Residual teeth present severe periodontal disease and compromised restorations.
Intraoral preoperative frontal view (left). Intraoral preoperative upper jaw occlusal view (center). Intraoral preoperative lower jaw occlusal view (right).
Smile of the patient before the surgery (left). Gummy smile analysis before the surgery (right).
Surgical procedure
Flap raising and bone exposure (left). Ridge regularization taking into consideration the amount of bone reduction needed to correct gummy smile appearance (center). Final level of ridge regularization (right).
Pilot osteotomy with OsseoDirector™ drill (left). Final osteotomy with OsseoShaper™ 1 (center). Placement of Nobel Biocare N1 Implant (right).
Lower jaw surgical phases, OsseoDirector drill (left). Final osteotomy with OsseoShaper 1 instrument (center). Nobel Biocare N1 Implant placement (right).
Upper jaw: Occlusal view after implant placement (left). Lower jaw: Occlusal view after implant and Multi-unit Abutment Xeal placement (right).
Restorative procedure
Provisional prosthesis delivered immediately after the surgery (left). Smile with provisional prosthesis (center). X-ray immediately after the surgery (right).
Try-in of monolithic zirconia structure (left). Nacera pearl shaded zirconia (right).
Cut back of the structure in order to perform a ceramic stratification to improve the esthetic result (left). Final rehabilitations ready to be delivered to the patient (right).
Final rehabilitation delivered to the patient 6 months after the surgery (left). Upper jaw occlusal view (center). Lower jaw occlusal view (right).
Outcome
Final esthetic result (left). Final smile result (center). X-ray with final rehabilitations 8 months after the surgery (right).
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