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ePaper created 2016-06-01, 10:23:49 | version 1.38.0
implants 2_2016 C.E. article_ fixed and removable implant restorations I I 09 traction of the patient’s remaining teeth followed by the immediate placement of eight dental im- plants. CBCT scans were taken to help determine the optimal placement of the implants within the available bone and away from the patient’s vital oral anatomy. Evaluation of the CBCT scan determinedthattherewassufficientheight,width andqualityofbonetoplacetheimplantsintheap- propriate locations and angulations via freehand surgery. Four 3.7 mm Inclusive Tapered Implants (Glidewell Direct; Irvine, Calif.) would be placed in each arch to support the fixed maxillary restora- tion and the removable mandibular prosthesis. At the surgical appointment, the patient’s remaining teeth were removed, and a flap was raised to visualize the socket sites and areas of implantation. Bone leveling was performed on thepatient’smaxillaryarchtoelevatethepatient’s smile transition line above the upper lip. The maxillary osteotomies were positioned to facilitate an All-on-4 configuration, with the posteriorimplantstiltedtomaximizetheanterior- posterior (A-P) spread, avoid the sinuses and ac- commodate the patient’s bone limitations (Fig. 3). Osteotomies were created for the placement of fourmandibularimplants,asopposedtothemini- mum of two required for a Locator overdenture. This would enhance retention of the overdenture while affording the possibility of upgrading to a fixed restoration at a later time. Following creation of the osteotomies, the im- plants were placed (Figs. 4a–4c). Inclusive Multi- Unit Abutments (Glidewell Direct) were attached to the maxillary implants, correcting for the divergent angulation of the implants. This would bothpositiontherestorativeplatforminamanner that would situate the screw access holes of the eventualprosthesistowardthelingualaspectand allow for a molar-to-molar restoration (Fig. 5). Note that when patients present for treatment with terminal dentition, they are commonly anx- ious about losing their teeth and the effect this Figs. 1a–1c_Preoperative condition of the patient. Note the high lip line, severe cervical decay present on the patient’s remaining teeth and lack of gingival support. (Photos/ Provided by Dr. Paresh B. Patel) Fig. 2_Preoperative panoramic X-ray exhibits periodontal disease, cervical caries, terminal state of the patient’s dentition and the compromised state of the surrounding periodontium, which had rendered the teeth mobile. Fig. 3_Maxillary implants with parallel pins in place exhibit the axial placement of the anterior implants and the tilted angulation of the posterior implants. Fig. 4a_Inclusive Tapered Implants by Glidewell Direct. Fig. 1a Fig. 1b Fig. 1c Fig. 2 Fig. 3 Fig. 4a