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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
| case report Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 21 cept. At the same time, an accurate and professional oral hygiene was done to improve the health of the gums and the patient was instructed on proper oral hygiene at home. With the help of a doctor, she stopped smoking and changed her eating habits, which means the reduction of an excessive con- sumption of food as well as avoidance of acidifying and sweetened drinks. We then proceeded with the maxilla tooth extractions and the immediate implementation of a full denture. After a few days of adaptation to the new situation, surgical and prosthetic operation for the application of the lower denture was planned. Once the teeth had been extracted, the bone ridge had been regularised and the mental foramens had been highlighted and isolated, we followed the "All-on-4" protocol by inserting two CAMLOG SCREW-LINE Promote plus® inclined distally with 30°, placed as distally as possible (Figs. 9–13) with the emergency above the foramen. Once checked the correct alignment with the "Vario SR Aligning" device we introduced the two medial implants and the Vario abutments, which will no longer be re- moved (Figs. 14 & 15). Once having sutured the wound with an absorb- able wire we proceeded with the connection of the impression copings by means of a resin with a very low ratio of contraction (Figs. 16 & 17) and with the polyether impression. The occlusal indexes have been identified beforehand. In the late afternoon of the same day it was applied to the temporary pros- thesis with a metal framework to grant rigidity to the implants. The prosthesis was extended up to the sec- ond premolar, with this achieving a "protection" of the distal extensions (Figs. 18 & 19). Four months af- ter the implant positioning in the upper arch (Figs. 20 & 21) we took an optical impression for the milling of the bar. After that we took the conventional impression in order to have a good mucous adapta- tion of the removable prosthesis (Figs. 22–26). For the retention of the prosthesis without the palate four OT Equator® attachments were screwed on the bar. Fig. 16: Abutments impression. Fig. 17: Detection of the impression: the four implants appear parallel thanks to the 30°-angled abutment mounted on the two distal, which compensates the inclination of the implants. Fig. 18: Temporary restoration: in transparency the stabilising bar implant. Notice the smooth surface and convex which allows easy hygiene by means of brush or floss. Fig. 19: Temporary restoration applied in the mouth. Fig. 20: Four CAMLOG SCREW-LINE® implants inserted in the maxilla. Fig. 21: Panoramic radiograph four months after implant surgery. 16 implants 2 2017