PMC5379076_01
Starting case, clinical frontal view of the patient.
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Considering the clinical exam (Figure 1), radiographic exams (Figures 2, 3, 4, and 5), and examination of models (Figure 6), specialists in periodontics, implantology, prosthetics, and orthodontics made a diagnosis suggesting that the multidisciplinary approach was the best therapeutic choice to adopt for this complex case.
Starting case, full-mouth intraoral radiographic exam.
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Considering the clinical exam (Figure 1), radiographic exams (Figures 2, 3, 4, and 5), and examination of models (Figure 6), specialists in periodontics, implantology, prosthetics, and orthodontics made a diagnosis suggesting that the multidisciplinary approach was the best therapeutic choice to adopt for this complex case. The radiographic check at one year (Figure 24) demonstrated no bone loss around implants and teeth compared to the starting condition (Figure 2).
Starting case, teleradiographic exam.
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Considering the clinical exam (Figure 1), radiographic exams (Figures 2, 3, 4, and 5), and examination of models (Figure 6), specialists in periodontics, implantology, prosthetics, and orthodontics made a diagnosis suggesting that the multidisciplinary approach was the best therapeutic choice to adopt for this complex case.
Initial case, TC Dentascan, axial view.
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Considering the clinical exam (Figure 1), radiographic exams (Figures 2, 3, 4, and 5), and examination of models (Figure 6), specialists in periodontics, implantology, prosthetics, and orthodontics made a diagnosis suggesting that the multidisciplinary approach was the best therapeutic choice to adopt for this complex case.
Initial case, TC Dentascan, cross-sectional images perpendicular to alveolar process of the maxilla.
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fig5
Considering the clinical exam (Figure 1), radiographic exams (Figures 2, 3, 4, and 5), and examination of models (Figure 6), specialists in periodontics, implantology, prosthetics, and orthodontics made a diagnosis suggesting that the multidisciplinary approach was the best therapeutic choice to adopt for this complex case.
Analysis of edentulous space.
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Considering the clinical exam (Figure 1), radiographic exams (Figures 2, 3, 4, and 5), and examination of models (Figure 6), specialists in periodontics, implantology, prosthetics, and orthodontics made a diagnosis suggesting that the multidisciplinary approach was the best therapeutic choice to adopt for this complex case.
Diagnostic wax-up, frontal view.
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A simulation of the final rehabilitation through a diagnostic wax was realized (Figures 7, 8, and 9) and analysed with the patient, aiming at highlighting what the advantages and disadvantages of the prostheses would be.
Diagnostic wax-up, lateral right view.
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A simulation of the final rehabilitation through a diagnostic wax was realized (Figures 7, 8, and 9) and analysed with the patient, aiming at highlighting what the advantages and disadvantages of the prostheses would be.
Diagnostic wax-up, lateral left view.
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A simulation of the final rehabilitation through a diagnostic wax was realized (Figures 7, 8, and 9) and analysed with the patient, aiming at highlighting what the advantages and disadvantages of the prostheses would be.
One month after nonsurgical periodontal therapy.
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One month after nonsurgical periodontal therapy had been completed (Figure 10), implant surgery was carried out.
Inserted pins.
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Paracrestal full-thickness flaps were elevated; consequently the osteotomy was realized following the surgical stent (Figure 11).
Implants placement.
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Three implants (Astra Tech OsseoSpeed TX Dentsply) were inserted in a prosthetic guided position in site 1.4 with implant 3.5 mm in diameter and 13 mm in length, in site 1.5 with implant 3.5 mm in diameter and 11 mm in length, and in site 1.6 with implant 4.0 mm in diameter and 9 mm in length, respecting the interimplant distance of 2-3 millimeters (Figure 12) according to Tarnow et al. and Elian et al., throughout the implant length to influence in a positive way osseointegration (Figure 13).
Rx control post-op.
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Three implants (Astra Tech OsseoSpeed TX Dentsply) were inserted in a prosthetic guided position in site 1.4 with implant 3.5 mm in diameter and 13 mm in length, in site 1.5 with implant 3.5 mm in diameter and 11 mm in length, and in site 1.6 with implant 4.0 mm in diameter and 9 mm in length, respecting the interimplant distance of 2-3 millimeters (Figure 12) according to Tarnow et al. and Elian et al., throughout the implant length to influence in a positive way osseointegration (Figure 13).
Conditioned soft tissue.
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After four months necessary to osteointegration and conditioning soft tissue (Figure 14) the impression was taken for the definitive rehabilitation.
Lower final impression.
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Periodontal probing was within normal limits, and no inflammation was recorded neither around the teeth nor around implants (Figures 15, 16, and 17).