Rehabilitation of a young patient with a severely degraded dentition
Dr. Ana Ferro
“The high implant and prosthetic survival rates of the All-on-4® treatment concept makes it a safe and predictable surgical protocol from both the clinician‘s and the patient‘s point of view. Clinicians should adopt this treatment concept in their daily practice to avoid demanding and time-consuming additional surgeries.”
Patient: male, 23 years old, healthy, smoker
Clinical situation: poor oral health. Severe deterioration in the maxilla, and of the molar teeth in the mandible. Remaining teeth show no sign of periodontal loss and mobility.
Surgical solution: Maxilla: All-on-4® treatment concept with NobelParallel CC implants. Mandible: Extraction of all molar teeth. Implant surgery 6 months after extraction: tooth 3.6 and 4.6
Restorative solution: Provisional: Malo clinic all-acrylic provisional bridge with Temporary Snap Coping Multi-unit Plus. Final: NobelProcera implant bridge, Kulzer Pala Premium teeth and artificial gingiva
Surgery date: October 2017
Total treatment time: Immediate delivery of all-acrylic provisional bridge, 10-day post-operative control
Case courtesy of Dr. Ana Ferro.
Some products may not be regulatory cleared/released for sale in all markets.
Please use landscape mode when viewing this page on mobile.
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).
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).
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.
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).
Maxilla healing 10-day post-operative. Abutments are cleaned and checked for loosening (left).
Intra-oral view 10-day post-operative (right).
X-ray after 4 months.
Before and after 30 days.
All-on-4® treatment concept
Life-changing treatment – a new smile in a day.
NobelParallel™ Conical Connection
A simply straightforward implant system.
Sign up for our blog update
Get the latest clinical cases, industry news, product information and more.
© Nobel Biocare Services AG, 2019. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. For prescription use only. Caution: Federal (United States) law restricts this device to sale by or on the order of a licensed clinician, medical professional or physician. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions. Nobel Biocare does not take any liability for any injury or damage to any person or property arising from the use of this clinical case. This clinical case is not intended to recommend any measures, techniques, procedures or products, or give advice, and is not a substitute for medical training or your own clinical judgement as a healthcare professional. Viewers should never disregard professional medical advice or delay seeking medical treatment because of something they have seen in this clinical case. Full procedure is not shown. Certain sequences have been cut.