Dr. Ana Ferro

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."

Case courtesy of Dr. Ferro

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

 

 

 

Case courtesy of Dr. Ana Ferro.

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Initial clinical situation

Case courtesy of Dr. Ferro

Front, side and profile images of the patient before treatment.

Initial clinical situation

Case courtesy of Dr. Ferro

Maxilla (left), mandible (right).

Initial clinical situation

Case courtesy of Dr. Ferro

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).

Restorative procedure

Case courtesy of Dr. Ferro

Pre-operative OPG.

Treatment planning

Case courtesy of Dr. Ferro

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.

Surgical procedure

Case courtesy of Dr. Ferro

The surgery starts with extraction of the remnant teeth.

Surgical procedure

Case courtesy of Dr. Ferro

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.

Surgical procedure

Case courtesy of Dr. Ferro

Bone reduction: performed due to a high smile line of 1 mm and the thin crest.

Surgical procedure

Case courtesy of Dr. Ferro

The All-on-4® Guide is placed in the midline and the anterior wall of the sinus is evaluated.

Surgical procedure

Case courtesy of Dr. Ferro

Preparation of osteotomies following the under-preparation protocol. Drilling is performed according to bone density in order to achieve good primary stability.

Surgical procedure

Case courtesy of Dr. Ferro

Placement of NobelParallel CC TiUltra RP 4.3x13 mm implant in the posterior.

Surgical procedure

Case courtesy of Dr. Ferro

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).

Surgical procedure

Case courtesy of Dr. Ferro

Placement of 30° Multi-unit Abutment Xeal CC RP 4.5 mm, tightened to 15 Ncm.

Surgical procedure

Case courtesy of Dr. Ferro

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.

Surgical procedure

Case courtesy of Dr. Ferro

Anterior implant placement: NobelParallel CC TiUltra NP 3.75 x 11.5 mm (left).

Multi-unit Abutment Xeal CC NP 2.5 mm (right).

Surgical procedure

Case courtesy of Dr. Ferro

Final occlusal view.

Restorative procedure

Case courtesy of Dr. Ferro

Impression taking using silicone putty and placement of healing caps.

Restorative procedure

Case courtesy of Dr. Ferro

Cylinder capture on immediate bridge.

Restorative procedure

Case courtesy of Dr. Ferro

Cylinder capture on immediate bridge with acrylic.

Restorative procedure

Case courtesy of Dr. Ferro

Provisional all-acrylic bridge in place.

Restorative procedure

Case courtesy of Dr. Ferro

Post-surgical OPG.

Restorative procedure

Case courtesy of Dr. Ferro

Suture removal 10 days after surgery.

Restorative procedure

Case courtesy of Dr. Ferro

Final prosthesis in articulator.

Restorative procedure

Case courtesy of Dr. Ferro

Final prosthesis on cast.

Restorative procedure

Case courtesy of Dr. Ferro

Final prosthesis.

Outcome

Case courtesy of Dr. Ferro

10 days after surgery.

Outcome

Case courtesy of Dr. Ferro

Before surgery (left).

10 days after surgery (right).

Outcome

Case courtesy of Dr. Ferro

Patient smile 10 days after surgery (left).

6-month follow-up (right)

Outcome

Case courtesy of Dr. Ferro

1-year follow-up.

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