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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
immediate, life-changing relief can be provided to patients suffering from terminal dentition or an un- comfortable, poorly functioning traditional denture. Further, the dramatic overhaul of this patient’s oral health demonstrates the life-changing capabilities of implant therapy, which helped him overcome se- vere functional and aesthetic challenges that were impacting practically every facet of his life prior to treatment. Case presentation A 47-year-old male presented with terminal den- tition in both arches resulting from periodontal dis- ease and severe caries (Figs. 1a–c). The patient had already lost many of his teeth, and the dentition that remained had been rendered unstable by his perio- dontal condition (Fig. 2). He had saved up enough money for a fixed implant restoration for his upper arch, for which he desired the most functional, lifelike prosthesis possible. While he couldn’t afford such a restoration for both arches, he wanted a retentive appliance for his mandible, with the option of later upgrading to a fixed prosthesis. The patient accepted a treatment plan in which his maxilla would be restored with a BruxZir Full-Arch Implant Prosthesis and his mandible with an Inclusive fixed and removable implant restorations CE article | Fig. 4a Fig. 4b Fig. 4c Locator Implant Overdenture. Fabricating his maxil- lary restoration from monolithic zirconia would en- sure maximum long-term durability. This was impor- tant provided the relatively young age of the patient, who would not have to worry about his upper pros- thesis succumbing to fractures, chips or stains. His lower appliance would be held in place by con- necting to the implants via LOCATOR attachments (Zest Dental Solutions), which are an economical means of improving prosthetic retention and stabil- ity. The overdenture caps that connect to the Locator Fig. 4a: Inclusive Tapered Implants by Glidewell Direct. Figs. 4b & c: The Inclusive Tapered Implants were threaded into place, achieving excellent initial stability. Fig. 5: Multi-unit abutment with carrier in place illustrates correction of the implant’s angulation to establish a uniform prosthetic platform around the arch. Fig. 6: Traditional dentures were fabricated in advance of the surgical appointment so they could be immedi- ately converted to serve as temporary appliances during the healing phase. Figs. 7a & b: Same day conversion of the maxillary denture to an immediate fixed prosthesis was achieved by adding multi-unit temporary cylinders using cold cure acrylic and trimming the appliance into a horseshoe shape. Figs. 8a & b: Note the dramatic change in the appearance of the pa- Fig. 5 Fig. 6 tient, who left with chairside-converted dentures in place on the same day as surgery, including a screw-retained, fixed provisional for his upper arch. Fig. 9: Postoperative panoramic radiograph illustrates All-on-4 config- uration of maxillary implants and axial placement of the mandibular implants, which would facilitate a passive fit of the lower overdenture. Fig. 7a Fig. 7b Fig. 8a Fig. 8b Fig. 9 CAD/CAM 2 2017 25