Fixed implant-supported rehabilitation of edentulous patient

The patient is an elderly lady with multiple medical conditions asking for dental implants to improve her masticatory function. The patient is taking multiple medications regularly for her hypertension and previous minor stroke. She does not smoke or drink and she is classified as ASA II. Immediate loading of dental implants in the edentulous jaws is considered a complex indication. In view of her advanced age and compromised general health, a less invasive approach was considered beneficial. As such, the All-on-4® treatment concept protocol for the mandible and later on a flapless implant surgery for the maxilla have been employed.

The salient points in the management of this case are:

1. CBCT examination was conducted to allow accurate diagnosis and planning; 

2. 3D models were produced as a communication tool to explain the procedures to patient;

3. All-on-4® treatment concept protocol for the mandible was performed and it was considered a minimal approach for the rehabilitation of the edentulous jaw. Four implants were used to support a full-arch restoration consisted of 12 units of teeth. In addition, immediate loading was routinely provided by given the patient a screw-retained provisional prosthesis;

4. NobelSpeedy™ Groovy TiUnite™ implants were used for good initial stability and highly osteoconductive surface;

5. A flapless procedure was employed for maxillary implant placement. The flapless approach was minimally invasive and was made possible by the CBCT study;

6. Immediate loading of the maxillary implants was provided by a screw-retained provisional prosthesis similar to the lower one;

7. Definitive prostheses were designed and manufactured using the NobelProcera™ CADCAM process. A hybrid design was selected for the lower arch and a full-ceramic Zirconia bridge was selected for the upper arch. The milled frameworks were biocompatible and precise. Screw-retained prostheses were retrievable and easier to maintain.

8. Regular maintenance was scheduled for good oral hygiene. In addition, it is important to ensure long-term success by preventing any biological and technical complication. Conclusion: The All-on-4® treatment concept protocol was effective and straightforward in rehabilitating the edentulous mandible. Both All-on-4® treatment concept protocol and flapless surgery were minimally invasive approaches. Immediate loading of the edentulous jaws was predictable.

In this case, madam Ho was very happy and satisfied with her screw-retained implant-supported prostheses.