PMC7603565_01
Preoperatory panoramic radiograph.
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fig1
As it can be observed in the orthopantomography (Figure 1), he was completely edentulous and used two conventional removable prosthesis.
The alveolar ridge after the osteotomy: the flat surface is necessary for the application of the surgical templates.
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The aim of this step is to obtain a flat surface and an adequate thickness on the ridge for the application of the surgical guides and the following implant insertion (Figure 2).
Intraoral view of the surgical steps (1): the first surgical guide is placed (a) and fixed (b), the central implant site is prepared thanks to metal bushings of increasing diameter (c, d), and the fixture is inserted (e, f).
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fig3
The first pin was thence removed and with the help of metal bushings of increasing diameter (from 3.00 mm to 5.00) mounted in the center bore on the guide the operator prepared the first implant site and inserted the fixture (Nobel Trefoil Implant 5.00 x 13 mm, Nobel Biocare, Zurich, Switzerland) (Figure 3).
Intraoral view of the surgical steps (2): the first surgical guide is removed (a) and the second is placed and fixed (b, c), the distal implants sites are prepared thanks to metal bushings of increasing diameter (d), and the fixtures are inserted (e).
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A surgical template with metal bushings on its ends, different from that used for the first implant, was applied on the surgical guide and used to prepare the distal implants sites (Figure 4).
All the implants are placed (a), and the prefabricated titanium bar is screwed on the fixtures (b, c).
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The surgical flap is sutured around the healing caps.
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Three particularly designed transfers are screwed on the implants and splinted with composite.
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Extraoral view of the prosthesis before its insertion (a, b) and intraoral occlusal (c) and buccal (d) view once it has been screwed.
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PMC7603565_02
The OPT was taken immediately after the surgery (a), at six months (b), and during the last control visit (30 months).
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The patient underwent a follow-up program and orthopantomographies were taken at six, eighteen, and thirty months after the surgery (Figure 9).