With my case, I want to win a #ITIWS24freeticket to attend the ITI World Symposium 2024 from May 9-11 for free
Case Report:
Patient with Class II terminal dentition, vertical maxillary excess and short lip, high lip line, horizontal and vertical soft-tissue defects and vertical bone deficiency and an hour-glass Gluckman’s Class V anterior teeth roots positions is interested in performing a full arch maxillary implant-fixed prosthesis.
Case Discussion:
The widespread of FP3 for full-arch fixed prosthesis due to its simplicity of execution and predictability of immediate loading democratized full arch fixed prosthesis. However, some cases, particularly short or high mobility lip patients are not suitable for such treatment, as one cannot hide the transition zone of the prosthesis.
FP1 prosthesis are, arguably, the most comfortable, esthetic and easy to clean, and should be our goal as to recover the absent hard and soft tissues of the patients.
Conclusion
The proper use of diagnostic and planning tools available nowadays, such as digital smile design, digital implant planning, surgical guides and pre-surgical immediate loading prosthesis along with adequate surgical skills and soft tissue management allows us to show the patient, beforehand, the final result and deliver exactly what we propose to do.
Bibliography:
Dawson A, Martin WC, Polido WD. The SAC Classification in Implant Dentistry. Quintessenz Verlag. 2022 Mar
Gluckman H, Pontes CC, Du Toit J. Radial plane tooth position and bone wall dimensions in the anterior maxilla: A CBCT classification for immediate implant placement. J Prosthet Dent. 2018 Jul;120(1):50-56. doi: 10.1016/j.prosdent.2017.09.005. Epub 2017 Nov 29. PMID: 29195817.
Lips at rest. We're able to see vertical maxillary excess and short lips
High smile line. We're able to see big vertical and horizontal bone loss at 1st quadrant
Initial Lateral at Rest
Initial Lateral Smile
Calibrating ruler
Calibrating extra-oral and intra-oral photos
Calibrating extra-oral and intra-oral photos
Measuring out ideal esthetics
Ideal teeth proportions
Facial integration of ideal teeth proportions
Duplicate DSD information to digital wax up
Final teeth position
Plan implant position according to ideal esthetics
Plan implant position according to ideal esthetics. View of implant planning at site of upper right central incisor. Hour-glass maxila, very demanding surgical skills for immediate loading. Mandatory use of angulated transmucosal abutment.
Plan implant position according to ideal esthetics. Crestal sinus lift at site of second premolar.
Plan implant position according to ideal esthetics. Guided bone reduction.
Implant and bone reduction guides
Gallucci's Provisional
With the help of a teeth supported guide, we pinned the base plate at the right position
Surgical Implant Guide in place
Implants placed and scalloped bone reduction performed
Soft tissue management
Post op 15 days. Amidst suture removal
Follow up 3 months at rest
Smile at follow up 3 months
Lateral View follow up 3 Months at rest
Lateral smile at follow up 3 months
Intra Oral at 3 months
Intra Oral at 3 months at 45º
Before and After 3 months
Profile before and after 3 months
DSD Planning
Merge of before and after and DSD planning
Merge of final result with provisional at 3 months and DSD planning, showing predictability and precision
Free-hand changes to communicate with lab. Shapes need to be improved.
Radiographic 15 month follow-up.
Comparison between final Prosthesis and DSD Planning
Final Prosthesis. If I win the ticket, I'll show you the final result and the video of the surgery.
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