Rehabilitation of a young patient with a severely degraded dentition

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).

Surgical procedure

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).

Restorative procedure

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.

Restorative procedure

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).

Outcome

Maxilla healing 10-day post-operative.  Abutments are cleaned and checked for loosening (left).

Intra-oral view 10-day post-operative (right).

Outcome

X-ray after 4 months.

Outcome

Before and after 30 days.