All-on-4® treatment concept
Dr. Enrico Agliardi
Italy
“Thanks to the new Xeal surface, I can get early soft tissue healing and sealing around the abutment. Xeal abutments are a must-have product for all clinicians performing immediate loading procedures.”
Patient: 65, female, fully edentulous in both jaws
Clinical situation: wearing total removable dentures
Surgical solution: All-on-4® treatment concept, NobelParallel™ CC TiUltra™ RP 4.3 x 13 mm, Multi-unit Abutment Xeal™
Restorative solution: NobelProcera® implant bar with composite teeth (planned)
Surgery date: September 23, 2019
Total treatment time: approximately 7 months (April 2020)
Initial clinical situation
Front, side and profile images of the fully edentulous patient. Note the lack of lip support because of the bone resorption.
Initial clinical situation
Intraoral view with removable dentures in both maxilla and mandible (left).
Moderate ridge resorption with estimated bone quality of D3 to D4 in the maxilla and D2 to D3 in the mandible (right).
Initial clinical situation
Occlusal view of the maxilla (left).
Mandible showing unfavorable ridge form (right).
Surgical procedure - Maxilla
Making a palatal incision for flap elevation (left).
Full-thickness flap elevation in the maxilla (right).
Surgical procedure - Maxilla
Preparing the osteotomy in the midline using a Ø 2 mm Twist Drill for insertion of the All-on-4® Guide (left).
Confirming angulation with the direction indicator (center).
Placing the All-on-4® Guide for predictable positioning of implants (right).
Surgical procedure - Maxilla
Twist Drill in the posterior and placement of NobelParallel CC implant with TiUltra™ surface (left images).
Implant inserted until collar and implant inserted in the posterior (right images).
Surgical procedure - Maxilla
Opposite side: posterior osteotomy preparation and implant placement (left images).
Use of Multi-unit Aligning Instrument to find the suitable Multi-unit Abutment angle (right images).
Surgical procedure - Drill protocol
Anterior implants: steps of the osteotomy preparation.
Surgical procedure - Maxilla
Multi-unit abutments Xeal™.
Surgical procedure - Maxilla
Flap closure and suturing.
Surgical procedure - Mandible
Raising the flap in the mandible (left).
Isolation of alveolar nerve (right).
Surgical procedure - Mandible
Making an osteotomy in the midline using a Ø 2 mm Twist Drill for insertion of the All-on-4® Guide (left).
Evaluating the direction of the osteotomies using direction indicators (center).
Occlusal view of the osteotomies (right).
Surgical procedure - Mandible
Implant insertion in posterior positions.
Surgical procedure - Mandible
All implants placed (left).
Closing and suturing the flap (center).
Healed soft tissue around Multi-unit Abutments Xeal™ (right).
Restorative procedure
Immediate provisional prostheses, planned before surgery in articulator after facebow registration (left).
Prosthesis finalized after the surgery before delivery to the patient (right).
Restorative procedure
Healed maxilla and mandible. Note the healthy soft tissue 2 weeks after surgery.
Restorative procedure
2 months after implant insertion and placement of Temporary Snap Copings on Multi-unit Abutment Xeal™ (left).
Finalization of the temporary prosthetic.Occlusal view shows Temporary Coping access holes blocked (right).
Restorative procedure
13 months after implant insertion (left).
13 months after implant insertion with the final prostheses (right).
Restorative procedure
Final prostheses 13 months after implant surgery.
Outcome
Before and after rehabilitation with the All-on-4® treatment concept (left).
Smile close-up before (top right) and after rehabilitation of the patient with the All-on-4® treatment concept (bottom right).
Outcome
13 months after surgery.
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All-on-4® treatment conceptLife-changing treatment – a new smile in a day.
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NobelParallel™ Conical ConnectionA simply straightforward implant system.
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Xeal™ and TiUltra™Welcome to the Mucointegration™ era. Surface chemistry cells can’t resist.
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