Frontal view of initial situation.

The pre-ordered surgical template is being used for the fabrication of the cast in the dental office.

Intaglio view of modified existing denture, now used as fixed-removable provisional denture.

Intraoral view 6 weeks after surgery.

0 Evaluation & Diagnosis
1 Treatment Planning
2 Progress & Completion

Patient cases:

Complete-arch treatments

(Maxilla / Edentulous)

Fully edentulous maxilla - a "different" treatment approach

Lead:

Lambert Stumpel

"Reference implants" have been used to treat this edentulous mandible in order to maintain the attached tissue. The aim was to re-position the old removable denture in its original position to be able to transfer it into a cement-retained provisional denture. This cement-retained provisional denture will be fixed onto CAD/CAM titanium abutments which have been fabricated prior to the surgery.

6 implants have been placed in the mandible, evenly distributed and loaded with a 6-unit bridge in the anterior zone and two 3-unit bridges in the posterior.

Evaluation & Diagnosis

Frontal view of initial situation.

Occlusal view of initial situation.

Evaluation of bone quantity in NobelClinician software.

Treatment Planning

Digital planning of the implant placement with NobelClinician.

Very narrow bone structure in the premolar area. When measuring the greyness values those were negative.

Digital planning of the implant placement in the tuberosity region.

Bone structure availability - drawn planning of implant placement.

Thorough planning with NobelClinician simplifies the next treatment steps.

Progress & Completion

The pre-ordered surgical template is being used for the fabrication of the cast in the dental office.

Regular polyvinyl siloxane (PVS) material is used for the alveolar part (pink color).

For the base of the cast, stiff polyvinyl siloxane (PVS) material is used (yellow color).

Cast with duplicate of the initial denture.

Cast with vacuform of the duplicate denture. This will help as a guide to cut the cylinders placed on the cast to the right angle and height.

Fixation of Multi unit abutments.

Multi unit abutments in place.

Placement of the temporary cylinders. This denture is being "jumped" in the dental office and not sent to the lab.

Placement of the temporary cylinders. These cylinders will be cut at the right angle and height.

Splinting of the temporary cylinders with dental floss.

Splinting of the temporary cylinders with triad (composite material) to get a stiff base with the cylinders related to each other.

Splinted temporary cylinders for precise transfer of implant position.

Splinted temporary cylinders for precise transfer of implant position.

Modified temporary abutments and vacuform of the initial denture. The vacuform serves as guide to cut down the abutments to the prosthetic height.

Modified cylinders with the right prosthetic height and angulation.

Fabrication of a flexible transfer jig.

Flexible temporary cylinder transfer jig. This allows for a quick insertion of the cylinders into the patient's mouth.

Adaption of the flexible jig to simplify placement during surgery.

Fit of the surgical template. Limited mouth opening.

Vacuform over initial denture.

The same vacuform is used as a guide to pre-drill the implant access holes.

Existing denture converted.

Osteotomy.

Guided placement of temporary cylinders with help of flexible jig. The flexible transfer jig is used to quickly insert all cylinders into the mouth.

Due to the narrow bone structure, the implant has been placed deeper but the abutment of the implant couldn't fit. The guided bone mill was used in order to create the right fit for the abutment.

Periapical radiograph: examination of the implant with the abutment in question.

Periapical radiograph: examination of the implant with the abutment in question.

Intaglio view of modified existing denture, now used as fixed-removable provisional denture.

Occlusal view of the modified and converted existing denture, now used as fixed-removable provisional denture.

Provisional denture placed without any complications, thanks to the extensive treatment planning.

Panoramic radiograph 3 weeks after implant placement with the all acrylic provisional bridge.

Intraoral view 6 weeks after surgery.

Intraoral view 6 weeks after implant placement: 6 maxillary implants placed.

Post-op CT scan.

Post-op CT scan.

Questions

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Team members

Lambert Stumpel

Implantologist

Walter Haechler, MDT

Dental technician

JP Simon, MDT

Dental technician

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