Immediate esthetic and functional rehabilitation of a complete mouth using the All-on-4® treatment concept
Dr. Enrico Agliardi
Patient: 59-year-old, female.
Clinical situation: Failing dentition in the upper and lower jaw due to severe periodontal disease, compromised function.
Surgical solution: Extraction of compromised residual teeth and placement of 4 Nobel Biocare N1™ implants in the maxilla and 4 intraoral implants in the mandible following the All-on-4 surgical protocol.
Restorative solution: Full zirconia implant bridge (Nacera).
Surgery date: March 2021.
Total treatment time: 6 months.
Tooth position: All.
Despite adequate bone volume, the case presents several challenges both surgically and prosthetically. From a surgical point of view, the management of an extensive gummy smile has been planned to be corrected through an osteotomy calibrated on extra and intraoral images prior to surgery. Prosthetically speaking the delivery of an immediate rehabilitation of both arches is another challenge faced during the case, due to the lack of reference points and severely compromised esthetics which has been managed through careful planning of the prosthesis manufactured prior to surgery. The key factor for the success was extensive presurgical planning using diagnostic records and photographs.
Case courtesy of Dr. Enrico Agliardi.
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Initial clinical situation
Preoperative X-ray. Residual teeth present severe periodontal disease and compromised restorations.