Case 105 | The Award 2017 | Philippines
Dr. Ricky Martin Llorca
the case: female, 49 years old. complaining of loose denture and difficulty in mastication & speaking.
clinically: upper jaw-kennedy class 3 modification 2. lower jaw kennedy class 1 modification 1. old denture esthetically acceptable but poor in retention & function
radiographically: upper anteriors with deficient residual ridge, posteriorly with extreme development of sinus with marked thinning ofthe alveolar process and the roots of the remaining tooth projects into the sinus. lower deficient residual ridge all over the edentulous area but with thick body of the mandible and enough height & clearance from the mandibular canal.
recommendation: upper jaw needs bone augmentation, a block graft for the anterior and bilaterral sinus lifting and grafting. since the patient is reluctant of invasive procedure.
instead we proposed a combination of fixed and removable denture to improved the functions and retention. lower jaw also needs bone augmentations if conventional implant and crown are to be planned but instead we proposed a lesser invasive and faster treatment which is the “all on four treatment concept”
treatment plan: 1st lower – cbct diagnosis, implant planning, restorations planning.
2nd lower – surgical guide fabrication, local anesthesia, implant placement surgery old denture relining.
3rd lower- 6 weeks healing, provisional fixed denture (Hybrid)
4th lower- pick up impression of implants, crown & bridge of the 4th quadrant try-in & installation of the final hybrid denture.
5th upper- crown & bridge preparations, Bridge try-in with precision attachment, bridge pick up impression, bridge and RPD try-in, bridge cementation and RPD installation.
results: Denture esthetic on both upper and lower is achieved, stability and retention is remarkable.
most importantly the patient is satisfied in all aspects of the denture function.
2-pre-op stayplate denture upper & lower
4-pre-op pseudo panoramic
6-manual surgical guide
8-post implant surgery
9- low profile abutment+ quickbridge aafter 6 weeks
11-conversion of old denture to hybrid
12-trim & polishing of provisional hybrid
13-implant post-op pano
14-implant post-op cbct
15-6 months post provisional
16- impression for final hybrid denture
17- OCR+framework of final hybrid
18-wax try-in of final hybrid +temp crown
19- finished hybrid-lower
20- installation of final hybrid-lower
21- upper PFM bridge + male precision attachment +milling job
22-RPD + female precision attachment +milling job
23- upper RPD + precision attachment in place
24- lower hybrid denture in place
25- upper & lower prosthesis in place
27-post op happy
28-post op 2 months later
29- chief complain
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