PMC7518501_01
(a) Preoperative cone-beam computed tomography. (b) Preoperative orthopantomogram
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F1
After clinical and radiological assessments [Figure 1], considering the available bone and labial support, two treatment options had been presented to the patient: implant-supported overdentures or implant-supported hybrid dentures.
Postimplant placement
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F2
Postanalyzing the cone-beam computed tomography and hematological investigation, it was planned to restore maxillary and mandibular ridges with multiple implant-supported hybrid prosthesis after extraction of periodontically compromised maxillary and mandibular teeth [Figure 2].
Postimplant placement orthopantomogram
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F3
After 6 months of waiting period, an orthopantomogram [Figure 3] was done to ensure the osseointegration.
(a) Healing abutments in maxilla. (b) Healing abutments In mandible
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F4
Verification of customized tray
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F5
The custom tray was verified in the patients' mouth, and open-tray impression copings [Figure 5] were attached to the implants after healing caps were removed [Figure 6].
Soft-tissue contour after removal of healing abutments
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F6
The custom tray was verified in the patients' mouth, and open-tray impression copings [Figure 5] were attached to the implants after healing caps were removed [Figure 6].
Splinting of open-tray transfer copings
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F7
These copings were splinted with ligature wire with the help of pattern resin [Figure 7].
Maxillary and mandibular impressions
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F8
Verification of Jig trial
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F9
The jig trial was verified in the patients' mouth [Figure 9] over two implant sites in the maxillary and mandibular arch, the castable abutments were placed, and a denture base was made.
(a) Baseplate engaging castable abutment. (b) Jaw relation was recorded
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F10
Occlusal rims were fabricated, and using Niswonger's technique, the jaw relation and tooth selection were recorded [Figure 10].
(a) Articulated Try-in. (b) Try-in in patient's mouth
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F11
Casts were mounted on semi-adjustable articulator followed by teeth arrangement with acrylic teeth [Figure 11].
Hybrid prosthesis with access hole buccally
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F12
The maxillary and mandibular hybrid prosthesis were fixed along with implant abutments at sites 11, 13, 15, 17, 21, 23, 24, 27, 33, 35, 37, 43, 45, and 47 through occlusal screws using torque wrench [Figure 12].
(a) Final Prosthesis. (b) Post-insertion OPG
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F13