PMC6498813_01
Presurgical panoramic radiograph of the patient.
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fig1
A series of meticulous clinical and radiographic evaluations including CBCT scans were carried out (Figure 1).
A = occlusal view of the completed virtual implant placement and computer-aided design and computer-aided manufacturing (CAD/CAM) surgical guide.. B = CAD/CAM surgical guide after fabrication.. C = flapless implant placement through the metal sleeves of the CAD/CAM surgical guide.. D = intraoral view of two mandibular implants immediately after implant placement.
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fig2
Two mandibular implants were virtually placed with respect to the treatment plan. (Figure 2A). After the fabrication of the mandibular surgical guide (Figure 2B), its fit was intraorally verified. The implants (4 x 13 mm, NobelReplace Straight Groovy, Nobel Biocare, Yorba Linda, CA, USA) were placed through the metal sleeves in the surgical guide (NobelGuide, Nobel Biocare, Yorba Linda, CA, USA) with a flapless surgical approach (Figure 2C, D) after completing the implant socket preparations.
A = internal view of the implant-retained mandibular overdenture.. B = intraoral view of the patient after both duplicate trial dentures were inserted.. C = intraoral view of the patient with new denture teeth were arranged.. D = intraoral view of the patient after both maxillary complete denture and implant-retained mandibular overdenture were delivered.
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fig3
Both duplicate dentures were inserted intraorally and occlusal vertical dimension and centric relation (Figure 3B) were confirmed. The clear teeth on the duplicate dentures were eliminated by grinding, and new denture teeth (Ivoclar Vivadent, Amherst, NY, USA) were arranged on the duplicate dentures (Figure 3C). The two metal housings were attached to the mandibular denture with autopolymerizing acrylic resin and an implant-retained mandibular overdenture was fabricated (Figure 3D).