Patient cases:

Multi-unit restorations

(Maxilla)

Minimally invasive treatment a partially dentate elderly patient with dynamic navigation to place a tilted implant

Lead:

Luca De Stavola

An 80-year-old female patient presented with a fractured root on a distal fixed partial prosthesis element. Her case was solved with an immediate flapless implant placement using dynamic navigated surgery and immediately provisionalized implants mesially tilted.

Her relevant medical history reveals she is using anticoagulants and antihypertensive drugs. Over and above that, her dental history includes generalized gingivitis, localized periodontitis on tooth #1.5 FDI (#4 US) and recently, pain in the area of tooth #1.4 FDI (#5 US) due to a vertical root fracture.

In the clinical examination, she presents with tooth wearing in the lower jaw, a fixed partial prosthesis in the upper jaw, missing teeth #1.8, #1.7, #1.6, #1.4 FDI (#1, #2, #3, #5 US), and a fixed partial prosthesis over tooth #1.5 to #1.3 FDI (#4 to #6 US) with a distal cantilever of tooth #1.6 FDI (#3 US) restored almost 20 years ago. The patient has a bone quality type III and limited bone quantity due to the sinus position in the area of teeth #1.6 and #1.7 FDI (#3 and #4 US). Due to the vertical root fracture, buccal bone resorption on tooth #1.5 FDI (#4 US) is observed.

Evaluation & Diagnosis

Intraoral view of the initial situation of the first quadrant.
Patient presents with a fixed partial prosthesis over tooth #1.5 to #1.3 FDI (#4 to #6 US) with a distal cantilever.

Initial examination of the periapical x-ray:
vertical root fracture and pain in the area of tooth #1.4 FDI (#5 US).

Surgical video

Extraction tooth #1.5 FDI (#4 US), immediate implant placement in position 1.4 and 1.6 tilted mesially to avoid the interference with maxillary sinus anatomy.

Progress & Completion

Provisional over implant:
immediate implant placement in position 1.4 and 1.6 tilted mesially to avoid interference with maxillary sinus anatomy.

Lateral view of the provisional fixed partial prosthesis fabrication:
application of acrylic and polishing of the restoration to correct the critical and subcritical contours.

Immediate temporary fixed partial prosthesis over implants.
After 4 months, screw-retained CAD/CAM monolithic zirconia fixed partial prosthesis was performed.

Periapical x-ray
at follow-up of 2 months using the provisional over implants.

Follow-Up & Outcome

Intraoral picture of the provisional over implants

8 weeks follow-up of provisional over implants.

6 months follow-up:
zirconia monolithic fixed partial prosthesis on #1.4 to #1.6 FDI (#3 to #5 US).

Questions

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asked by Ruth Bloechlinger

Why use a Nobel Active and a Parallel CC

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Question posted by moderator on behalf of FOR.org community member.

Ruth Bloechlinger

10.11.2020 | 09:42

I used an active 3.5 in the 1.4 position so to have optimal primary stability and reduced implant diameter, in the position 1.6 I used a parallel 3.75mm diameter so to increase the mechanical resistance keeping the implant diameter relatively small. (Answer posted by moderator, on behalf of author, Dr. Luca De Stavola)

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asked by Ruth Bloechlinger

My plan would be as follows:

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Separate the bridge from distal to the canine, and extract tooth the second bicuspid. Then place 3 implants at the area of first and second bicuspid and short implant at the first molar area. Then connect them all with one bridge. (Comment posted by moderator on behalf of FOR.org community member)

Ruth Bloechlinger

10.11.2020 | 10:20

It is an option, in the area of the second bicuspid the bone was limited in dimension due to the infection around the tooth so I preferred to avoid the implant in that area an have the space to tilt the distal implant. (Posted by moderator on behalf of author, Dr. Luca De Stavola)

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asked by Ruth Bloechlinger

I have the following question related to the case (click on details):

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A flapless immediate procedure was used to place implants,at # 14 and # 16 to replace failed FPD.I noticed no surgical guide was used clinically or confirmation of angulation and depth of pilot drill radiographically.Did I miss something or was it done freehand due to experience of the surgeon.Thanking you in anticipation. (Posted by moderator on behalf of FOR.org community member)

Ruth Bloechlinger

10.11.2020 | 10:22

The surgery was performed using the x-guide technology, so it was fully guided surgery but using a dynamic control of implant 3D positions. For these reasons no x-ray are needed during the surgery (Posted by moderator on behalf of author, Dr. Luca De Stavola)

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asked by Thomas Varghese

Abutment on #5

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Hi its a good case . Can u tell was a multi unit or what abutment was used on # 5

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asked by Ruth Bloechlinger

Comment: New X-Guide workflow with X-Mark

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X Mark is a great new addition to the X-Guide workflow. It allows me to virtually plan a case using the patient’s diagnostic scan and then accurately register the virtual plan to the patient for a predictable navigated surgery every time. No X-Clip in the scan means fewer appointments for the patient. (Comment posted by moderator on behalf of Dr. Robert Pauley.)

Minimally invasive treatment a partially dentate elderly patient with dynamic navigation to place a tilted implant

Evaluation & Diagnosis

Progress & Completion

Follow-Up & Outcome

Questions

Why use a Nobel Active and a Parallel CC

My plan would be as follows:

I have the following question related to the case (click on details):

Abutment on #5

Comment: New X-Guide workflow with X-Mark

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