0 Evaluation & Diagnosis
1 Treatment Planning
2 Progress & Completion
3 Follow-Up & Outcome

Patient cases:

Multi-unit restorations

(Maxilla / Anterior)

Immediate placement and loading in the anterior maxilla

Lead:

Mithridade Davarpanah

This patient presented for rehabilitation of an extended maxillary edentulous space. In addition, the bone was missing horizontally and vertically. The patient was seeking a fixed anteroposterior rehabilitation of the maxilla. Bone was insufficient horizontally and vertically and autologous bone grafting seemed necessary. However, the patient could be rehabilitated without any grafting by using artificial pink gingiva and implants with bone expansion properties. Immediate provisionalization could also be delivered on the same day as surgery.

Evaluation & Diagnosis

Frontal view of the extended edentulous area.........

Occlusal view of the edentulous area.

Present rehabilitation of the edentulous area with a removable prosthesis.

Occlusal view of the mandible with a removable prosthesis.

Panoramic radiograph. Not much valuable information can be obtained from this radiograph in the hands of the patient.

Treatment Planning

Simulation with 5 NobelActive implants in the antero-posterior area.

Site #22 (FDI), situation of the planned implant in the mesio-distal direction.

Site #22 (FDI), transverse section of the site.

Site #22 (FDI), transverse section at the site with measurements of the width of the alveolar crest. Note that there is no sufficient width to host an implant of Ø 3.5mm.

Site #22 (FDI), transverse section with the planned implant, a Ø 3.5x15 NobelActive implant. There is not enough bone width to obtain a vestibular lamella of at least 1mm.

Site #11 (FDI), situation of the planned implant in the mesio-distal direction.

Site #11 (FDI),transverse section.

Site #11 (FDI), transverse section of the site with measurements of the width of the alveolar crest. Note that there is no sufficient width to host an implant of Ø 3.5mm.

Site #22 (FDI), transverse section with the planned implant, a Ø 3.5 x 15 NobelActive implant. There is not enough width to get a vestibular lamella of at least 1mm.

Site #13 (FDI), situation of the planned implant in the mesio-distal direction.

Site #13 (FDI) ,transverse section.

Site #13 (FDI), transverse section with measurements of the width of the alveolar crest. Note that there is no sufficient bone width to host an implant of Ø 4.3mm.

Site #13 (FDI), transverse section with the planned implant, a Ø 4.3 x 15 NobelActive implant. There is not enough bone width to get a vestibular lamella of at least 1mm.

Site #15 (FDI), situation of the planned implant in the mesio-distal direction.

Site #15 (FDI), transverse section.

Site #15 (FDI), tranverse section with measurements of the width and height of the alveolar crest. Note that there is enough width to host a standard implant of Ø 4.3mm.

Site #15 (FDI), transverse section with the planned implant, a Ø 4.3 x 15 NobelActive implant. There is enough bone width to get a sound vestibular lamella.

Site #16 (FDI), situation of the planned implant in the mesio-distal direction.

Site #16 (FDI), transverse section.

Site #16 (FDI), transverse section with measurements of the width and height of the alveolar crest. Note that there is enough width to host a standard implant of Ø 4.3mm.

Site #16 (FDI), transverse section with the planned implant, a Ø 4.3 x 15 NobelActive implant. There is enough bone width to get a sound vestibular lamella.

Occlusal view of the simulation with the corresponding implants.

Progress & Completion

Surgical guide.

Occlusal view with the guide in place before surgery.

1-week control after surgery, at suture removal.

Note the low smile line.

2-month control. Soft tissue healing is well advanced, note the long teeth of the provisional prosthesis.

5-month control. Healing was uneventful and the final prosthetic steps can be undertaken.

Occlusal view of the temporary prosthesis.

Soft tissue situation at prosthesis removal to take the impression.

Occlusal view of the soft tissues. Note the multi-unit abutments and the gingival arrangement around the abutments.

Impression taking with plaster.

Plaster key on the master cast to check the reliability of the impression.

Check of the reliability of the impression with the plaster key.

Definitive prosthesis on the master cast.

Occlusal view of the definitive prosthesis on the master cast.

Frontal view of the definitive prosthesis.

Occlusal view of the definitive prosthesis.

Frontal view of the definitive prosthesis at time of delivery.

Occlusal view of the screw-retained prosthesis.

Surgical video

Impression taking

Prosthesis delivery

Follow-Up & Outcome

1-year recall after definitive prosthesis delivery. Frontal view.

1-year recall after definitive prosthesis delivery. Occlusal view.

Demonstration on how to perform the maintenance care at home.

Demonstration on how to perform the maintenance care at home.

Panoramic radiograph at delivery of the provisional prosthesis, i.e. the same day of surgery.

Periapical radiograph with the temporary prosthesis taken after 5 months in the posterior area. Note the multi-unit abutments.

Peripaical radiograph taken after 5 months in the anterior area. Note the multi-unit abutments.

Panoramic radiograph at delivery of the definitive prosthesis.

Periapical radiographs of the definitive prosthesis at delivery, 5 months after surgery.

Periapical radiograph 1-year after definitive prosthesis delivery. Posterior area. Note that the platform-shifting prevented any crestal bone loss.

Periapical radiograph at 1-year recall after definitive prosthesis delivery. Anterior area. The crestal bone level has been stable.

Questions

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Team members

Implantologist

Szmukler-Moncler Serge

DDS; PhD, Scientist

Rajzbaum Philippe

DDS, PhD, Prosthodontist

Capelle-Ouadah Nedjoua

DDS, Clinical Monitor

Demurashvili Georgy

DDS, Surgeon

Davarpanah Keyvan

DDS, Prosthodontist

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