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

Patient cases:

Single-unit restorations

(Mandible / Posterior / Edentulous)

Replacement of a fixed partial denture with three implants

Lead:

Giorgio Tabanella

A 52-year-old patient is a referral and has been wearing an immediate provisional partial denture after replacement of her worn and fractured fixed partial denture. As a definitive treatment solution, the patient desired "beautiful and long-lasting" implant-supported single crowns. Clinically the CT-scan revealed a very narrow bone crest ("knife-edge") in the 3rd quadrant. Implant placement has been planned with a simultaneous GBR procedure.

Evaluation & Diagnosis

Initial situation; provisional crown on tooth #34 (FDI) / #21 (US) with a distal cantilever #35 (FDI) / #20 (US)

Occlusal view of the initial situation. The left mandibular ridge is very narrow (knife-edge).

Cast of the initial situation.

Periodical radiograph of the initial situation.

Initial CT-scan to evaluate the bone quantity.

Evaluation of bone structure and nerve pathway.

Evaluation of bone structure and nerve pathway

Treatment Planning

Diagnostic wax-up.

Buccal view of the surgical template (resin duplicate of wax-up).

Occlusal view of the surgical template (resin duplicate of wax-up).

Surgical template for implant placement.

Progress & Completion

Mandibular ridge before surgery. Tooth #34 (FDI) / #21 (US) will be extracted and replaced by an implant.

Surgical template in place.

Buccal view of incision.

Occlusal view of incision.

Intra-operative radiograph to check the correct implant positioning.

3 implants placed.

Occlusal view of implant placement #34(FDI) / #21(US), #35(FDI) / #20(US), #36(FDI) / #19(US).

Submerged healing of implants is indicated after bone grafting.

Occlusal view of the sutures.

Uncovering of implants after a sufficient healing time.

Periapical radiograph post surgery.

Periodical radiograph 4 months after implant placement.

Periodical radiograph of implants loaded with CAD/CAM-fabricated titanium abutments.

Minor exposure of cover screws 3 months after the surgery.

Custom-made CAD/CAM titanium abutments.

Occlusal view of custom-made CAD/CAM titanium abutments.

Provisional restoration.

Occlusal view of provisional bridge. The crowns are still splinted.

Provisional restoration after two weeks of soft tissue remodelling.

Lithium disilicate framework.

Try-in of framework.

Occlusal view of framework.

First bake and soft tissue conditioning for definitive restoration.

Definitive lithium disilicate single crowns.

Definitive restoration.

Occlusal view of definitive restoration.

Follow-Up & Outcome

Smooth soft tissue adaption around the crowns, 1 month after the delivery of the definitive lithium disilicate restoration.

Lingual view of soft tissue adaption.

Close up of gingival margin.

Periodical radiograph of the definitive restoration.

Questions

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Anonymous

30.08.2026 | 13:38

I have a case with lower right posterior gap of 28mm mesial- distal length. Patient is missing Lower right 456.please advise

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