Dental rehabilitation with immediate implant placement and loading with temporary fixed dental prosthesis (FP-3 by Karl Mish).

Initial situation

A 67-year-old female patient presented a complaint on the unsatisfactory appearance of her teeth and low quality of mastication and food processing (Fig. 1 - 4). The patient also reported a decreased quality of life and social maladjustment. She expressed a strong unwillingness to wear a removable prosthesis due to an expressed gag reflex.

Her medical records showed a history of periodontitis. Most of the remaining previously treated teeth presented with purulent discharge have a hopeless long-term prognosis. The patient recently recovered from an acute cerebrovascular accident and had hypertension under control. Clinical examination revealed partially edentulous upper and lower jaws with a total adentia in posterior regions.

Treatment planning

Considering the patient’s remaining dentition, a possibility would be to re-treat the multiple endodontically treated teeth and perform new fixed prosthesis. This intervention would also involve treating and controlling the periodontally compromised teeth, as well as the placement of dental implants in the posterior edentulous areas. However, the patient indicated no further willingness to go through extensive treatment time. She expressed a preference for replacement of the teeth with dental implants with a fully functional fixed prosthesis. After careful examination of the residual bone on the CBCT, I considered that high primary stability (and high insertion torque) could be obtained through the use of the Straumann® Bone Level Tapered (BLT) Implants. Furthermore, an implant-borne full-arch restoration could be undertaken using the Straumann® Pro Arch BLT concept. An immediate implant placement and provisionalization was chosen, to deliver immediate function and aesthetic appearance. Grafting with bovine deproteinized bone substitute was considered focally for dimensionally compromised bone sites mainly associated with the post extraction sockets.

The following treatment plan was agreed with the patient. Total tooth extraction with a simultaneous placement of 6 Straumann BLT SLActive implants in maxilla and mandible. Placement of SRA abutments supporting the temporary fixed dental prosthesis was followed by the final prosthesis.

Surgical procedure

After atraumatic tooth extraction (Fig. 5 - 6), and levelling of the alveolar ridge, the Straumann BLT SLActive implants were inserted in the tooth positions 12, 14, 16, 22, 24, 26, 32, 34, 36, 42, 44, 46, while the SRA abutments (Fig 7 - 9) and protective cups were also installed. Bone defects were filled with autogenous bone chips (harvested during osteotomy preparation), followed by deproteinised bovine bone (Fig. 10). After suturing, a primary closure was achieved (Fig. 11 - 12).

After this, the temporary copings were installed (Fig. 13) and a pre-fabricated temporary prosthesis was fixed the next day (Fig. 14 - 17).

Prosthetic procedure – final prosthesis

Re-examination was performed 10 weeks afterwards with the ortopantomogram (Fig 18) confirming successful short-term outcomes. The patient noted a high degree of satisfaction with the aesthetics and functioning of the temporary prosthesis. As a result, they agreed to transition to the permanent construction.

After the removal of the temporary prosthesis, abutment level open tray impressions were taken (Fig. 19 - 21) followed by the bite registration. Screw-retained hybrid prosthesis for upper and lower jaw were produced and fixed (Fig. 22 - 24).

Treatment Outcome

The final X-ray 2.5 months post-op shows stable bone and clinical examination with stable soft tissues (Fig. 25). The patient is highly satisfied with the outcome. They have taken on a much more active social role, as a result of the convenience and comfort of wearing permanent fixed dental prosthesis.

Treatment Outcome

This case illustrates the successful use of BLT design, hydrophilic SLActive surface implants in achieving fast and predictable full-arch rehabilitation by utilising the Straumann ProArch concept.