Tooth extractions, fabrication of bar denture mounted on 4 implants (All-on-4) Treatment phase II – Implant surgery (Case presentation) (60 )

Male patient, aged 57

Antecedents:

• During the previous treatment sessions all the patient’s teeth were removed due to uncontrolled periodontal disease and neglect.
• The patient was given a provisional denture for the 3-month healing period.
• The completely edentulous jaws are now ready for implant surgery.

 
Treatment phase II, implant surgery, reline of provisional denture (3 workdays)

The treatment could resume following 3 months’ healing with the installation of implants. For the accurate assignment of the site and size of the implants a CBCT (Cone beam computed tomography) scan was made to examine residual bone mass in 3 dimensions prior to the intervention.

CT scans in which the residual bone mass of the jawbones can be examined and based on which the site and size of the implants can be assigned:

Taking into account our patient’s requirements and financial means, we opted for 4 implants to be fixed in the lower and upper arch each which would support bar dentures. In addition to stability, bar dentures have the great benefit that implants can be aligned with the residual bone mass, and axial discrepancies can be remedied with implant bars, which eliminates the necessity of a bone-graft. The provisional denture made after tooth extractions was relined in keeping with the altered anatomical relations. It is important to minimise the wearing time of provisional dentures following implant surgery. Patients are advised to wear provisional dentures only to work or at places where they are required to talk and smile. When at home, provisional dentures should be removed immediately. Please keep the denture and the mouth clean and see that the implanted area is not exposed to pressure and that the provisional denture does not “wiggle” on the implants/gingiva formers. Pressure exerted by the denture compromises blood circulation, hinders healing, may cause denture sores and infection, or, worst of all, the rejection of the implant, however well the implant was installed.

Follow-up panoramic radiograph following implant surgery

The treatment may resume following 5 months’ healing by exposing the upper two implants and sealing them with healing abutments. The fabrication of the permanent restoration is due in one month’s time.