Case 33 | Prosthodontic Award 2015 | USA
Dr. Kan Wongkamhaeng
Full-mouth Rehabilitation of an Edentulous Patient with Dental Implants: A Digital Approach
A 53-year-old male presented seeking comprehensive esthetic and functional rehabilitation. Patient reported difficulties in functioning with his ill-fitting complete dentures. After a comprehensive examination, treatment options were offered, including conventional complete dentures, implant-retained overdentures and implant-supported fixed prostheses. The patient selected a full-mouth rehabilitation with implant-supported fixed prosthesis constructed with monolithic zirconia for maxillary arch and metal-resin implant fixed complete denture for mandibular arch.
A diagnostic teeth arrangement was completed to verify the esthetic and occlusion, and later, was duplicated and used as radiographic guide. An evaluation of the cone beam computed tomography (CBCT) images revealed vertical bone deficient at maxillary first molars areas (Siebert Class II).
Bilateral, lateral window approach sinus augmentations were performed.
Endosseous implants (OsseoSpeedTM TX, Dentsply, MÖlndal, Sweden) were placed at sites #21, 23, 26 and 28, along with alveoloplasty on the mandibular arch, and sites #3, 6, 8, 9, 11, and 14, using computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guide for maxillary arch.
Later, healing abutments were replaced with 20o UniAbutments. Abutment level impressions were made with polyvinylsiloxane material (ImprintTM 3 VPS, 3M ESPE, St. Pual, MN, USA). The accuracy of the casts was evaluated with the verification index. Artificial teeth were arranged and tried in to verify esthetic, facial contour, occlusal vertical dimension, and centric relation. Interim implant-supported fixed prostheses were fabricated by the duplication of arranged teeth.
Mandibular cast and teeth arrangement were submitted for the fabrication of implant-supported suprastructure (AtlantisTM ISUS, Hasselt, Belgium).
The maxillary definitive restoration was designed with CAD/CAM software (3Shape Dental SystemTM CAD/CAM software, Denmark) and copy-milled in zirconia (Zenostar Zirconia ceramic, Wieland, Germany). Gingiva aspects were contoured and festooned with lithium disilicate (IPS e.max, Ivoclar Vivadent, Amherst, NY).
Mandibular definitive prosthesis was custom stained and processed with heat-polymerized acrylic resin (Lucitone, Dentsply/York Division, York, PA).
At delivery, restorations were secured and torqued to 15 Ncm. Esthetic, phonetic, and occlusion was verified. The screw access holes were sealed with shade A1 composite resin (Kerr). The occlusion was re-verified using articulating paper. A maxillary occlusal splint was also fabricated to protect the restorations from possible parafunctional habits.