PMC5308079_01
Pretreatment photograph - Note the lack of fullness of the upper lips and sunken cheeks
JIPS-17-74-g001.jpg
PMC5308079_01_JIPS-17-74-g001.jpg
F1
Science, Kerala, India with a chief complaint of bad smell and irritation in her lower front gum region [Figure 1]. She gave a history of hypertension and hypothyroidism and was under medication for the same.
Initial photo - Combination syndrome-like situation. Artificial teeth in cross bite relation
JIPS-17-74-g002.jpg
PMC5308079_01_JIPS-17-74-g002.jpg
F2
Posteriorly, she had a removable acrylic temporary denture with clasps extending onto the canines bilaterally [Figure 2].
Initial panoramic view - Lone standing mandibular canines with severe periodontitis and severe resorption in the mandibular molar region
JIPS-17-74-g003.jpg
PMC5308079_01_JIPS-17-74-g003.jpg
F3
The panoramic view revealed a severe bone resorption on the mandibular molar area and a combination syndrome-like appearance on the mandibular anterior area [Figure 3].
After the acrylic bridge removal - The arrows indicate severe inflammation gingival inflammation in response to the ill-fitting bridge
JIPS-17-74-g004.jpg
PMC5308079_01_JIPS-17-74-g004.jpg
F4
The acrylic bridge, which did not follow the ridge contour, had to be removed first [Figure 4] as it harbored plaque and food debris resulting in gingival inflammation.
Implant stability assessment using RFA, Osstell ISQ  (resonance frequency analysis). During each assessment, the healing abutment has to be removed, and the smart peg mounted directly onto the fixture to facilitate the reading
JIPS-17-74-g005.jpg
PMC5308079_01_JIPS-17-74-g005.jpg
F5
The implant stability was assessed using the resonance frequency analysis (Osstell implant stability quotient [ISQ], Gothenburg, Sweden) [Figure 5].
Healing abutments are placed
JIPS-17-74-g006.jpg
PMC5308079_01_JIPS-17-74-g006.jpg
F6
PMC5308079_02
PMC5308079_03
Postoperative panoramic view after 3 months
JIPS-17-74-g007.jpg
PMC5308079_03_JIPS-17-74-g007.jpg
F7
Postoperative panoramic and intraoral periapical view [Figures 7 and 8] of the implants suggested the predictable levels of osseointegration.
Intraoral periapical view after 4 months. (a) 33 region and (b) 43 region
JIPS-17-74-g008.jpg
PMC5308079_03_JIPS-17-74-g008.jpg
F8
Postoperative panoramic and intraoral periapical view [Figures 7 and 8] of the implants suggested the predictable levels of osseointegration.
PMC5308079_04
Healing abutments replaced with ball abutments. The gingival health restored
JIPS-17-74-g009.jpg
PMC5308079_04_JIPS-17-74-g009.jpg
F9
Healing abutments were replaced with ball abutments [Figure 9].
A light body polyvinyl siloxane impression (Aqausil, Dentsply, India) was made to delineate the location of the ball abutments
JIPS-17-74-g010.jpg
PMC5308079_04_JIPS-17-74-g010.jpg
F10
The male portion of the attachment was placed into the denture base through the direct technique sequential placement of the attachment and is described using [Figures 10-14].
A through pencil mark was made on the denture base
JIPS-17-74-g011.jpg
PMC5308079_04_JIPS-17-74-g011.jpg
F11
The male portion of the attachment was placed into the denture base through the direct technique sequential placement of the attachment and is described using [Figures 10-14].
Adequate relief given with the help of a straight bur was given such that there is no contact with the male component and the denture base during centric occlusion
JIPS-17-74-g012.jpg
PMC5308079_04_JIPS-17-74-g012.jpg
F12
The male portion of the attachment was placed into the denture base through the direct technique sequential placement of the attachment and is described using [Figures 10-14].
The undercut created between the lower edge of the matrix and the retentive anchor abutment is blocked out with modeling wax
JIPS-17-74-g013.jpg
PMC5308079_04_JIPS-17-74-g013.jpg
F13
The male portion of the attachment was placed into the denture base through the direct technique sequential placement of the attachment and is described using [Figures 10-14].
After incorporating the male portion into the denture base with self-cure acrylic. Voids existing between the matrix and the denture base are filled with acrylic, and the denture is finished and polished
JIPS-17-74-g014.jpg
PMC5308079_04_JIPS-17-74-g014.jpg
F14
The male portion of the attachment was placed into the denture base through the direct technique sequential placement of the attachment and is described using [Figures 10-14].
Postdenture insertion (frontal view)
JIPS-17-74-g016.jpg
PMC5308079_04_JIPS-17-74-g016.jpg
F15
The patient was completely satisfied with her new dentures in terms of function and esthetics [Figures 15 and 16].