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Dr. Ana Ferro

Rehabilitation of a young patient with a severely degraded dentition

Dr. Ana Ferro

Portugal

“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.”

Case courtesy of Dr. Ferro

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.

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Case courtesy of Dr. Ferro

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.

Case courtesy of Dr. Ferro

Initial clinical situation

Severe tooth decay and absence of prosthetic space, especially in the posterior sectors (left).

Bite evaluation (right).

Case courtesy of Dr. Ferro

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).

Case courtesy of Dr. Ferro

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.

Case courtesy of Dr. Ferro

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).

Case courtesy of Dr. Ferro

Outcome

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

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

Case courtesy of Dr. Ferro

Outcome

X-ray after 4 months.

Case courtesy of Dr. Ferro

Outcome

Before and after 30 days.

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