PMC7501563_01
Maxillary (a, b) and mandibular (c, d) teeth condition: multiple carious lesions, absence of ferrule-effect, and periodontal and other changes, which demands for extraction of all decayed teeth.
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According to the patient, he loses his teeth gradually over 20 years due to caries and its complications (Figure 1).
Dental implants positions on maxilla (a, b) and mandible (c, d).
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Placement and sizes of dental implants were chosen after evaluation of bone situation and position of virtual prosthetic construction (Figure 2).
Positioning surgical template (a) and full-guided surgical template (b).
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Thus, maximum accuracy of the full-guided template was achieved on working on edentulous jaws (Figure 3).
Full-guided surgical template attaching to the upper jaw (a). The condition of the jaw after placement of 8 dental implants by using flapless method with installed implant drivers (b).
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The criteria for the flapless surgery were an adequate amount on the bone for implant placement, the presence of 2 mm thickness each bone on buccal and palatal sides around implant as planned in a favourable prosthetic position (which defined by using CBCT analysis), and the presence of sufficient keratinised attached gingiva (it must be at least 3 mm around the each implant) (Figure 4).
Full-guided surgical template attaching to the mandible (a). The condition of the jaw after placement of 8 dental implants by using standard protocol (b).
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Intraoperative selection of 30 degrees multiunit abutments at the front side of maxilla and installation healing caps at the distal side.
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Thus, all of the multiunit abutments were installed intraoperatively with a torque equal to 25 Ncm, and their removal was not performed in the future (Figure 6).
Final prosthetics after 3 month healing (a). Good condition of soft tissues on maxilla (b) and mandible (c) after wearing temporary screw-retained multiunit abutment-supported restorations.
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Temporary prosthetic constructions were installed to prepared plaster models, which were mounted on the articulator SAM 3 (SAM PRAZISIONSTECHNIK GmbH, Gauting, Germany) (Figure 7).
Final look of the zirconia full-arch prostheses. Afterwards, the titanium bases were inserted.
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After some adjustments, the restorations in full anatomy were milled in monolithic zirconia block (KATANA Zirconia STML, Kuraray Noritake Dental Inc., Aichi, Japan) (Figure 8) and were sintered, colourised, and then glazed.
Final look of the prostheses on maxilla (a) and mandible (b). Patient's joyful smile (c).
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Functional specificities, including group function, interocclusional contacts, no contacts on protrusive and lateral excursions, were achieved by minor selective modifications, central fossa expansions on premolars and molars and teeth appearance reduction (Figures 9 and 10).
Occluding prostheses: left side (a), front side (b), and right side (c).
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Functional specificities, including group function, interocclusional contacts, no contacts on protrusive and lateral excursions, were achieved by minor selective modifications, central fossa expansions on premolars and molars and teeth appearance reduction (Figures 9 and 10).
Condition and level stability of the bone tissue around dental implants after 12 month of prosthetics. (a) Is maxilla and (b) is mandible.
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CBCT scanning was taken after 12 months, and no any bone resorption around implant platform was found (Figure 11).