Prosthodontics: João Borges, DDS
Lab: MALO CLINIC Ceramics
Clinical Team Location: Lisbon, Portugal
Website: www.maloclinics.com
Specialties: Oral Surgery, Implantology, Prosthodontics
Title: All-on-4TM Bimaxillary Rehabilitation
Prosthetics: Upper - MALO CLINIC Ceramic Bridge, Lower - MALO CLINIC Acrylic Bridge
A 59 year-old male patient presented with a hopeless clinical condition and requested a solution for his unsatisfactory aesthetic and functional problems which persisted for years.
Clinical and radiographic examination revealed an extremely poor prognosis for the remaining natural dentition. Almost all the remaining teeth were destroyed by secondary dental caries with periapical lesions or presented with vertical bone loss.
Extraction of all teeth and rehabilitation with a fixed prosthesis supported by 4 implants (All-on-4TM Concept) was the treatment plan presented for both jaws. In this case, NobelSpeedyTM Groovy Implants RP 4x15mm were used in the posterior regions (both arches) with 4mm, 30º Multi-Unit Angled RP Abutments (Branemark System®). In the anterior regions, the implants used were NobelSpeedyTM Groovy RP 4x15mm (both arches) with 2mm, Multi-Unit RP Abutments (Branemark System®).
Though simultaneous rehabilitation was possible, the patient opted for a staged approach: the All-on-4TM mandibular surgery was performed the day after the maxillary surgery.
A few hours after both surgeries, immediate fixed bridges were placed and were maintained for a period of 6 months to allow for osseointegration and tissue stabilization. During this period, the occlusal contacts on the immediate bridges were limited to the inter-canine region, avoiding occlusal forces on the cantilevers.
In a second phase, a new temporary bridge was fabricated, where the desired function, aesthetics, and gingival adaptation were achieved.
The rehabilitation was completed 6 months after surgery by placing a MALO CLINIC Ceramic Bridge in the maxilla - 12 ceramic crowns cemented over 12 copings supported by a NobelProceraTM CAD/CAM System titanium infrastructure (Nobel Biocare™ AB, Gothenburg, Sweden) – and a MALO CLINIC Acrylic Bridge was placed in the mandible. This case highlights "All-on-4TM" as an excellent treatment option.
Case Photos
Initial OPG
Initial situation: Extra-oral frontal view in smile position
Initial situation: Intra-oral frontal view
Intra-oral, frontal view. Final rehabilitation: MALO CLINIC Ceramic Bridge in the maxilla and MALO CLINIC Acrylic Bridge in the mandible.
Extra-oral, frontal view (smile) after conclusion of the definitive rehabilitation.
Final clinical situation. Final OPG.
