Clinical case of an edentulous maxilla

Overview

Situation: Edentulous maxilla
Solution: Full-arch reconstruction with immediate provisionalization using the All-on-4^® treatment concept and NobelParallel Conical Connection implants.
Oral surgeon: Dr. Armando Lopes, DDS, MSc, Malo Clinic
Prosthodontist: Dr. Carlos Moura Guedes, DDS, Malo Clinic
Laboratory: Maloceramics

Treatment planning

Patient: 37-year-old female, edentulous in the upper jaw, rehabilitated with a denture 22 years ago.

Chief complaint: Patient complained about poor retention of the prosthesis and recurrent fractures. Her main concern was related to the esthetic requirements that restrained her from getting employment. The patient’s main goal was to obtain a fixed implant-supported rehabilitation that fulfilled the functional and esthetic demands.

Overall health: History of previous epilepsy. Non-smoker.

Oral examination: After evaluating the radiological exams (OPG and CBCT scan) it was assessed there was moderate resorption in the maxilla (residual bone at least 5 mm width and 10 mm bone height between the canines), a high smile line (visible gingival tissue between 2-5 mm in maximum smile) and mouth opening capability of over 50 mm.

Decision: It was proposed to perform a full-arch fixed rehabilitation with an immediate provisional prosthesis. A 3D treatment plan was previously obtained using the NobelClinician software. The surgery combined guided and freehand approaches, using a NobelGuide pilot drill surgical template to prepare the initial osteotomy of the four NobelParallel Conical Connection implants.

Total treatment time: Six months to final prosthesis. Immediate temporary prosthesis just after surgery.

Highlighted products used:

• Bone Mill
• Multi-unit Abutment Plus and Temporary Snap Copings
• NobelParallel Conical Connection implants
• NobelGuide pilot drill surgical template

Treatment summary

Since the patient’s removable prosthesis did not meet the functional and esthetic requirements, a new upper prosthesis was fabricated. This presented optimal design with a correct representation of the teeth position and a perfect fit with the soft tissue, while keeping in mind that the radiographic guide will be converted exactly into a surgical template.

Reference points: Gutta-percha markers were incorporated into the radiographic guide in order to facilitate the subsequent matching of the two CBCT scans in the NobelClinician software. The patient with the radiographic guide and the radiographic guide alone were scanned following the double-scan protocol and by using the calibration object.

The two CBCT scans were matched and correct 3D treatment planning was achieved using the NobelClinician software. Four NobelParallel Conical Connection implants were selected for this rehabilitation: two tilted regular platform (4.3x11.5 mm) posterior implants and two narrow platform (3.75x10 mm) anterior implants. 

A mucoperiosteal flap (full thickness flap) was raised along the top of the ridge with vertical incisions on the buccal aspect in the molar area. The surgical template was used as a guide to prepare the initial osteotomy for four NobelParallel Conical Connection implants.

Result

"Thanks to this treatment I had the chance to restore not only my teeth but also my life. Now I’m much more positive, confident and happy because I can smile, kiss and eat properly. I was feeling older than my years but now I feel young again. Thank you to the entire team for this incredible result!"

Lilia Tavares, Portugal

"The All-on-4^® treatment concept enables us to treat edentulous patients better, faster and easier. Fixed provisional teeth can be delivered on the same day of surgery¹ with a predictable protocol offering high success rates. In this challenging case we were able to successfully deliver fixed new teeth to this young patient."

Dr. Armando Lopes, Portugal

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