0 Evaluation & Diagnosis
1 Treatment Planning
2 Progress & Completion

Patient cases:

Complete-arch treatments

(Posterior / Edentulous)

Treatment of a maxillary failing dentition including digital treatment planning

Lead:

Regina Mericske-Stern

This patient case shows the rehabilitation of failing dentition in the maxilla, including digital treatment planning. In the course of a full mouth rehabilitation, the mandible was also included in the treatment process to receive a satisfying functional and esthetic result.

Chief complaints:

facial appearance
instable maxillary denture

Evaluation & Diagnosis

Initial situation. Locked bite and inverse overjet, overbite.

Locked bite and inverse overjet, overbite.

Initial situation. No TMJ symptoms, minimal loss of VDO.

Initial situation. Sore neck muscles, normal mandibular jaw movements.

Initial situation of maxilla.

Existing removable denture.

Initial periapical radiograph.

Initial periapical radiograph.

Treatment Planning

Prospective implant positions evaluated with NobelClinician.

Planned placement of three well-distributed implants in the maxilla.

Occlusal view of planned placement of three well-distributed implants in the maxilla.

3D treatment planning for the anterior implant: standard surgery.

3D treatment planning for the right posterior implant: planned sinus floor elevation with a lateral window, one-stage procedure.

3D treatment planning for the left posterior implant: planned sinus floor elevation with a transcrestal approach.

Esthetic analysis

Progress & Completion

Lateral sinus floor elevation, one-stage (tooth #16 FDI / #3 US).

Lateral sinus floor elevation with the bone substitute material and simultaneous implant placement.

Standard implant placement in the anterior zone with the healing cap in place for submerged healing.

Transcrestal sinus floor elevation with simultaneous implant placement in region #26 (FDI) / #14 (US).

Occlusal view of the healed site after a healing period of 7 months.

Re-entry: uncovering of the implants after 7 months of submerged healing.

Implant #16 (FDI) / #3 (US): periapical radiograph after re-entry and placement of ball abutment.

Implant #21 (FDI) / #9 (US): periapical radiograph after re-entry and placement of ball abutment.

Implant #26 (FDI) / #14 (US): periapical radiograph after re-entry and placement of ball abutment.

Definitive maxillary overdenture: horseshoe design.

Intaglio view of the definitive restoration.

Lateral view of the definitive restoration: note the vertical axis of the anterior teeth and the buccal flange to help correct the occlusion.

Provisional restoration for the lower right quadrant on master cast.

CAD/CAM fabricated provisional crown and bridge for the lower right quadrant.

Lateral view of the definitive restoration for the mandible: Zirconia bridge and crown.

Occlusal view of the definitive restoration for the mandible: Zirconia bridge and crown.

Definitive restoration on master cast: the patient did not wish to close the gap on the left side.

Intraoral view of the definitive restoration.

Intraoral view of the mandible with the definitive restoration in place.

Frontal view of the face before (left) and after the treatment (right).

Lateral view of the face before (left) and after the treatment (right).

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Team members

Prosthodontist

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