C2 ◊Page C1 Straumann Pro Arch Treatment planning Considering the patient remain- ing terminal dentition, and after a careful clinical and radiographic as- sessment; a full arch rehabilitation with 4 implants in the maxilla using Straumann BLX Implants with the Pro Arch concept was planned. The posterior implants were tilted due to limited bone availability in the maxilla caused by the pneumatized maxillary sinuses. Furthermore, im- mediate implant placement and provisionalization were chosen in order to deliver immediacy concept and aesthetic appearance the same day of surgery with a provisional acrylic-metal-reinforced prosthesis. Surgical & Prosthetic procedures A mucoperiosteal fl ap was elevated to expose the palatal and buccal bone, and the extraction of tooth #25 with resection of the cyst in the same location was performed (Fig 4-6). Alveoplasty of the maxilla and exposure of the nasal cavity was performed with a sub-nasal lift pro- cedure to have a bicortical anchor- age of the anterior axial implants protecting the nasal membrane (Fig 7-9). Implant osteotomies were performed with tilting orientation 30º for posterior implants in posi- tion #16 & #25, avoiding the pneu- matized maxillary sinuses; and two axial implant osteotomies in posi- tion #12 & #22, to achieve an implant apical anchorage in the nasal fl oor (Fig 10-13). We selected 2 Straumann BLX 3,75x18mm Roxolid SLActive for posterior tilted implants and 2 Straumann BLX 3,75x12mm Roxolid SLActive for anterior axial implants (Fig 14,15). The insertion of the Strau- mann BLX implants was performed IMPLANT TRIBUNE Dental Tribune Middle East & Africa Edition | 2/2021 obtaining optimal torque values of at least 35 Ncm for all implants, being able to perform a predictable imme- diate loading of the prosthesis (Fig 16-20). We placed two straights Screw-re- tained Abutments diameter 4.6mm, GH 3.5mm for the anterior implants and two Screw-Retained Abutments 30º diameter 4.6mm, GH 4.5mm for the posterior tilted implants (Fig 21-22). Moreover, we performed a guided bone regeneration procedure with Straumann Xenograft and a Straumann Membrane Flex in the containing bone defect located on the mesial area of implant position #25 (Fig 23). The fl ap was closed with free-tension sutures. A panoramic radiograph post-op was taken before continuing with the prosthetic steps for the manu- facturing of the immediate loading prosthesis (Fig 24,25). Following the loading of the provi- sional prosthesis, a Cone-beam com- puted tomography (CBCT) was taken and a correct stabilization and fi t of the prosthesis was assured. Clinical front-lateral pictures were also reg- istered. Treatment outcomes An outstanding function and aes- thetic result the same day of surgery was obtained using the immediacy Straumann Pro Arch concept. The Panoramic radiograph and CBCT to- mography showed an optimal distri- bution of the number of implants in the maxilla (Fig 26-29). About the author The patient was very happy to re- ceive immediately fi xed restora- tion that allowed him to recover the function and aesthetics that he was lacking, and more importantly his quality of life. He also received oral hygiene instructions and was involved in a maintenance program with regular check-ups. Testimonial by Dr. Vladimir García Lozada “Straumann BLX implant design is a great development that can trans- form a diffi cult case into an easy one. The hydrophilicity properties of the SLActiv surface helped us to enhance the healing process. The versatility of the BLX prosthetic components are an excellent advantage, one connec- tion for all implants. A reduced body of implant with large treads allowed us to perform a minimal osteotomy while obtaining optimal primary stability with great torque values; and the platform switching, a decrease bone resorp- tion in the crestal margin bone. I recently performed a great series of Pro Arch concept cases with BLX implants. The overall outcomes were very satisfactory, even in complex cases with atrophic jaws and poor bone quality”. Dr Vladimir García Lozada DDS, MS, PhD Dr Vladimir García Lozada is graduated in Dentistry, Oral Surgery and Maxillofacial Implantology from dif- ferent international programmes of Uni- versities and Hospitals. He went through a residency program in Oral and Maxil- lofacial Surgery in Brazil, and he qualifi ed for the degree Doctor of Philosophy in Oral and Maxillofacial Implantology PhD program at the Cambridge International University. His research interests and clini- cal activity include the techniques for the treatment of severe atrophies of the jaws with special focus in complex cases us- ing zygomatic and pterygoid implants, full-arch implant rehabilitations and new technologies with CAD/CAM 3D printing medical devices in the fi eld of maxillofa- cial applications. Lecturer of different Universities Pro- grammes in oral implantology as in train- ing courses, webinars and conferences on implant surgery for complex cases. He is the author of several articles in national and international journals and is a mem- ber of various scientifi c societies (IAOMS, SECIB, SEI, ICOI). Founder & CEO of Cibu- max for complex implant cases. www.cibumax.com Dentist. Fig.16 Fig.17 Fig.18 Fig.19 Fig.20 Fig.21 Fig.22 Fig.23 Fig.24 Fig.25 Fig.26 Fig.27 Fig.28 Fig.29