Dr. Enrico Agliardi

All-on-4® treatment concept

Dr. Enrico Agliardi

Italy

“Thanks to the new Xeal surface,  I can get early soft tissue healing and sealing around the abutment. Xeal  abutments are a must-have product for all clinicians performing immediate loading procedures.”

Case courtesy of Dr. Mintrone

Patient: 65, female, fully edentulous in both jaws

Clinical situation: wearing total removable dentures

Surgical solution: All-on-4® treatment concept, NobelParallel™ CC TiUltra™ RP 4.3 x 13 mm, Multi-unit Abutment Xeal™

Restorative solution: NobelProcera® implant bar with composite teeth (planned)

Surgery date: September 23, 2019

Total treatment time: approximately 7 months (April 2020)

 

 

 

Case courtesy of Dr. Enrico Agliardi.

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Case courtesy of Dr. Agliardi

Initial clinical situation

Front, side and profile images of the fully edentulous patient. Note the lack of lip support because of the bone resorption.

Case courtesy of Dr. Agliardi

Initial clinical situation

Intraoral view with removable dentures in both maxilla and mandible (left).

Moderate ridge resorption with estimated bone quality of D3 to D4 in the maxilla and D2 to D3 in the mandible (right).

Case courtesy of Dr. Agliardi

Initial clinical situation

Occlusal view of the maxilla (left).

Mandible showing unfavorable ridge form (right).

Case courtesy of Dr. Agliardi

Surgical procedure - Maxilla

Making a palatal incision for flap elevation (left).

Full-thickness flap elevation in the maxilla (right).

Case courtesy of Dr. Agliardi

Surgical procedure - Maxilla

Preparing the osteotomy in the midline using a Ø 2 mm Twist Drill for insertion of the All-on-4® Guide (left).

Confirming angulation with the direction indicator (center).

Placing the All-on-4® Guide for predictable positioning of implants (right).

Case courtesy of Dr. Agliardi

Surgical procedure - Maxilla

Twist Drill in the posterior and placement of NobelParallel CC implant with TiUltra™ surface (left images).

Implant inserted until collar and implant inserted in the posterior (right images).
 

Case courtesy of Dr. Agliardi

Surgical procedure - Maxilla

Opposite side: posterior osteotomy preparation and implant placement (left images).

Use of Multi-unit Aligning Instrument to find the suitable Multi-unit Abutment angle (right images).

Case courtesy of Dr. Agliardi

Surgical procedure - Drill protocol

Anterior implants: steps of the osteotomy preparation.

Case courtesy of Dr. Agliardi

Surgical procedure - Maxilla

Multi-unit abutments Xeal™.

Case courtesy of Dr. Agliardi

Surgical procedure - Maxilla

Flap closure and suturing.

Case courtesy of Dr. Agliardi

Surgical procedure - Mandible

Raising the flap in the mandible (left).

Isolation of alveolar nerve (right).

Case courtesy of Dr. Agliardi

Surgical procedure - Mandible

Making an osteotomy in the midline using a Ø 2 mm Twist Drill for insertion of the  All-on-4® Guide (left).

Evaluating the direction of the osteotomies using direction indicators (center).

Occlusal view of the osteotomies (right).

Case courtesy of Dr. Agliardi

Surgical procedure - Mandible

Implant insertion in posterior positions.

Case courtesy of Dr. Agliardi

Surgical procedure - Mandible

All implants placed (left).

Closing and suturing the flap (center).

Healed soft tissue around Multi-unit Abutments Xeal™ (right).

Case courtesy of Dr. Agliardi

Restorative procedure

Immediate provisional prostheses, planned before surgery in articulator after facebow registration (left).

Prosthesis finalized after the surgery before delivery to the patient (right).

Case courtesy of Dr. Agliardi

Restorative procedure

Healed maxilla and mandible. Note the healthy soft tissue 2 weeks after surgery.

Case courtesy of Dr. Agliardi

Restorative procedure

2 months after implant insertion and placement of Temporary Snap Copings on Multi-unit Abutment Xeal™ (left).

Finalization of the temporary prosthetic.Occlusal view shows Temporary Coping access holes blocked (right).

Case courtesy of Dr. Agliardi

Restorative procedure

13 months after implant insertion (left).

13 months after implant insertion with the final prostheses (right).

Case courtesy of Dr. Agliardi

Restorative procedure

Final prostheses 13 months after implant surgery.

Case courtesy of Dr. Agliardi

Outcome

Before and after rehabilitation with the  All-on-4® treatment concept (left).

Smile close-up before (top right) and after  rehabilitation of the patient with the  All-on-4® treatment concept (bottom right).

Case courtesy of Dr. Agliardi

Outcome

13 months after surgery.

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