PMC5371219_01
Edentulous mandibular arch with knife-edge ridge.
CRID2017-9373818.001.jpg
PMC5371219_01_CRID2017-9373818.001.jpg
fig1
The mandibular arch was also U-shaped with large curvature and knife-edge ridges (Figure 1).
Cone beam computed tomography (CBCT) findings showing very thin coronal portion of the alveolar ridge.
CRID2017-9373818.002.jpg
PMC5371219_01_CRID2017-9373818.002.jpg
fig2
The CBCT scan revealed a very thin Class IV type of alveolar ridge (knife-edge) (Figure 2).
Alignment of the four implants' position.
CRID2017-9373818.003.jpg
PMC5371219_01_CRID2017-9373818.003.jpg
fig3
Conical Connection NP 3.5 mm x 13 mm implants (Nobel Biocare, USA) were planned at the interforaminal region of the mandibular anterior region (Figure 3). Cover screws were placed on the implants and minor bone grafting using demineralised bovine bone matrix (BioOss, Geistlich, Switzerland) and barrier membrane (BioGide, Geistlich, Switzerland) was done to cover exposed threads at the #42 implant area.
Three 5 mm healing abutments placed on the remaining implants.
CRID2017-9373818.004.jpg
PMC5371219_01_CRID2017-9373818.004.jpg
fig4
Subsequently, the failed implant was removed while 5 mm healing abutments replaced the cover screws of the other three implants (Figure 4).
The intaglio surface of the mandibular interim denture is relined.
CRID2017-9373818.005.jpg
PMC5371219_01_CRID2017-9373818.005.jpg
fig5
The soft lining material was removed from the intaglio surface and relined with a denture repair acrylic resin material (Rebase II, Tokuyama, Japan) (Figure 5).
The teeth setup in wax.
CRID2017-9373818.006.jpg
PMC5371219_01_CRID2017-9373818.006.jpg
fig6
ARH, Sweden) and the teeth setup was done (Figure 6). Another appointment for clinical try-in was done to check the aesthetics and occlusion for the patient. After the patient accepted the clinical try-in, the dentures were then brought back to the laboratory to have an occlusal silicone index fabricated to locate the position of the mandibular denture teeth (Figure 7).
Silicone index registering the occlusal position of the denture teeth.
CRID2017-9373818.007.jpg
PMC5371219_01_CRID2017-9373818.007.jpg
fig7
ARH, Sweden) and the teeth setup was done (Figure 6). Another appointment for clinical try-in was done to check the aesthetics and occlusion for the patient. After the patient accepted the clinical try-in, the dentures were then brought back to the laboratory to have an occlusal silicone index fabricated to locate the position of the mandibular denture teeth (Figure 7).
Wax denture base with the denture teeth removed.
CRID2017-9373818.008.jpg
PMC5371219_01_CRID2017-9373818.008.jpg
fig8
After the impression copings were screwed onto the implants and verified with radiographs for complete seating, the copings were joined together by lacing the floss across the copings in a figure of "8" and subsequently strengthened with autopolymerization resin (GC Pattern Resin, Japan). Three items were required for the Nobel Procera scan: (1) master cast model, (2) wax denture base with teeth setup, and (3) wax denture base without teeth setup (the intaglio surface of teeth) (Figure 8).
Design of the framework using the Nobel Procera software.
CRID2017-9373818.009.jpg
PMC5371219_01_CRID2017-9373818.009.jpg
fig9
Facility in Japan through the software itself. For this case, the process of scanning and designing the suprastructure was done using the Nobel Procera scanner and software (Figure 9) located at the dental centre's in-house laboratory; thus the design could be controlled by the clinician.
Milled implant framework tried in the mouth.
CRID2017-9373818.010.jpg
PMC5371219_01_CRID2017-9373818.010.jpg
fig10
The implant bar framework was then received and tried in the patient's mouth (Figure 10).
Final prosthesis in the mouth.
CRID2017-9373818.011.jpg
PMC5371219_01_CRID2017-9373818.011.jpg
fig11
The dentures were issued to the patient with accompanying home care instructions (Figure 11).