62-year-old male wants fixed prosthesis. Remaining hopeless teeth. No TMJ or muscle problems. Both jaw have significant horizontal bone resorption with partial loss of the vertical dimensions (Class III alveolar crestal defects)
Treatment options (i) conventional complete full dentures, (ii) overdenture on dental implants with ball-head attachments, (iii) “All-on-4” and “All-on-6” with fixed dental prosthesis.
Procedures: All remaining teeth were extracted before 4 months of implant placement, was rehabilitated with an immediate complete denture.
Preliminary impressions, primary casts, mandibular and maxillary trays, Determination of the vertical relation, centric relation record, try-in of complete dentures. Digital volume tomography (DVT)- patient was wearing the denture, with each tooth in the denture attached to the gutta-percha to show the long axis of the tooth. After 3D virtual planning, fabricated surgical guides.
One hour before surgery, patient received (amoxicillin, 2 g) and rinsed his mouth (chlorhexidine). Sedation with local anesthesia.
During surgery, six implants (Xive S plus, Ø3.8 mm × 13 mm length, Dentsply Sirona) in the basal bone of the upper jaw (in the regions 15, 13, 11, 21, 23, 25), four implants (Xive S plus, Ø3.8 mm × 13 mm length, Dentsply Sirona) in the basal bone of the lower jaw (32, 35, 42, 45) with bone-supported surgical guide was fixed with three anchor pins to the basal bone. Four implants (15, 25, 35, and 45) were inserted and tilted at an angle of 30° to the bone, all other implants were oriented straight. Implants were torqued to 30–50 newton centimeters (Ncm) to allow immediate rehabilitation (Figure 2B).
The Xive MP abutments angled at 30° (Dentsply Friadent) were connected to implants 15, 25, 35, and 45 as the baseline pictures. The Xive MP straight abutment was connected to all other implants. All abutments were torqued to 30 Ncm. The SmartFix® concept (Dentsply Sirona) was used during the operation to ensure parallelism of the Xive MP abutment, which helps the fit with immediately relining the provisional prosthesis.
An acrylic, screw-retained provisional prosthesis with thin metal framework was loaded immediately 3 h after surgery due to relining the denture (Figure 3A). Postoperative amoxicillin (500 mg tablets, three times per day) for 5 days. Sutures were removed at the 2-week follow-up.
(A) Provisional prosthesis with thin metal framework, (B) Final prosthesis with milled titanium frameworks.
The definitive (CAD/CAM)-milled titanium frameworks were fabricated and tried intraorally for fine adjustments. Definitive denture base was made of light-cured acrylic, and the appropriate artificial teeth were selected. The final prosthesis was screw-retained. The patient was instructed regarding proper prosthetic care. Radiographic examination 2 years after surgery revealed good bone healing and no peri-implant complications.
(A–C) Preoperative clinical view of the treated patient, and (D–F) after prosthesis insertion.
Follow-up and maintenance: The patient was given instructions on interdental brush and super floss in addition to traditional brush and floss. Every 3 months for the first year and then every 6 months after that, routine follow-ups. One week after immediate loading, the first control appointment. Further follow-up visits 3 months, 6 months, 1 year, and 2 years.
The following summarizes the treatment algorithm of this case:
Step 1: Case selection and treatment planning.
Step 2: Extraction of remaining teeth and healing period.
Step 3: Insertion of immediate complete dentures.
Step 4: DVT for implant planning placement.
Step 5: Implants placement with fabricated template surgical-precision resin cylindrical guides and provisional prosthesis with thin metal framework.
Step 6: Final prosthesis with (CAD/CAM)-milled titanium frameworks.
Step 7: Follow-up and maintenance protocol.