Minimally invasive treatment a partially dentate elderly patient with dynamic navigation to place a tilted implant
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.
Image 1 - Intraoral view of the initial situation of the first quadrant. She presents a fixed partial prosthesis over tooth #1.5 to #1.3 FDI (#4 to #6 US) with a distal cantilever.
Image 2 - Initial examination of the periapical x-ray. Vertical root fracture and pain in the area of tooth #1.4 FDI (#5 US).
Image 1 - Provisional over the implant. Immediate implant placement in position #1.4 to #1.6 FDI (#3 to #5 US) tilted mesially to avoid the interference with maxillary sinus anatomy.
Image 2 - Lateral view of the provisional fixed partial prosthesis fabrication - application of acrylic and polishing of the restoration to correct the critical and subcritical contours.
Image 3 - Immediate temporary fixed partial prosthesis over implants. After 4 months, screwed CAD/CAM monolithic zirconia fixed partial prosthesis was performed.
Image 4 - Periapical x-ray follow-up of 2 months using the provisional over implants.
Image 1 - Intraoral picture of the provisional over implants.
Image 2 - 8 weeks follow-up of provisional over implants.
Image 3 - 6 months follow-up of zirconia monolithic fixed partial prosthesis restoring #1.4 to #1.6 FDI (#3 to #5 US).