What is this about?

• Understand how to approach full-arch mandibular rehabilitation in an elderly patient with advanced periodontal disease and systemic health concerns.
• Discover why Straumann® LOCATOR FIXED® was chosen as a stable, hygienic, and cost-effective alternative to conventional fixed prosthetics.
• Learn how this simplified treatment provided excellent esthetic and functional results, enhancing oral health and overall quality of life.

Introduction

Restoring masticatory function and esthetics in elderly patients with complex medical and periodontal backgrounds requires a careful balance of surgical precision, prosthetic planning, and patient-centered decision-making¹. This case report details the oral rehabilitation of an 85-year-old male with advanced periodontitis and generalized tooth mobility, who preferred a fixed prosthesis that was easy to clean to regain chewing efficiency and an esthetically pleasing smile. Financial limitations made conventional full-arch fixed solutions less feasible².

His medical history included insulin-controlled diabetes mellitus and cardiovascular disease managed with anticoagulants, conditions known to impact peri‑implant healing and implant success^3,4. After thorough clinical and radiographic assessment, all remaining mandibular teeth were considered hopeless. The chosen plan involved extraction, placement of four Straumann® Roxolid® SLActive® implants, and restoration using the Straumann® LOCATOR FIXED® system. The SLActive® hydrophilic surface supports accelerated osseointegration and high survival rates, even in medically compromised patients^5-7. The LOCATOR system offers prosthetic stability, professional retrievability for hygiene, and lower costs, advantages confirmed in systematic reviews⁸.

The LOCATOR FIXED® solution provided a stable, functional, and esthetic result that addressed both the patient’s clinical needs and economic constraints. It improved his oral function and quality of life. This clinical report highlights the clinical decision-making, surgical protocol, and prosthetic workflow that led to a successful, accessible rehabilitation for a medically and financially complex patient.

Initial situation

An 85-year-old male patient presented with pain and mobility in the lower teeth. He expressed a desire for a fixed solution that is easy to clean, aiming to restore proper chewing function and achieve a pleasant smile. His medical history includes diabetes mellitus managed with insulin and cardiovascular disease, for which he is also taking anticoagulant medication.

In the upper arch, he wore a well-adapted removable prosthesis and was satisfied with it. Clinical examination of the lower arch revealed deep periodontal pockets, gingival recession, clinical attachment loss, bleeding on probing, suppuration, and grade II–III tooth mobility. There was also plaque accumulation and generalized gingival inflammation, indicating poor periodontal health (Figs. 1,2).

Treatment planning

The treatment plan consisted of extracting all hopeless lower teeth, followed by the placement of four implants in prosthetically guided positions. The goal was to achieve good primary stability and maintain relative parallelism between implants to allow for the use of an implant-retained overdenture. After reviewing the available options, the patient chose to proceed with an implant-supported overdenture in the lower jaw, specifically selecting the LOCATOR FIXED® system due to its stability, ease of hygiene, and favorable long-term maintenance. Implant positioning was carefully planned based on CBCT analysis and restorative needs, while respecting anatomical limitations. This approach aimed to provide a fixed, functional, and hygienic prosthetic solution that met the patient’s expectations (Figs. 3-7).

Author’s testimonial

The Straumann® LOCATOR FIXED® system is an outstanding solution that combines the stability and comfort of a fixed restoration with the clinical flexibility of being removable for professional hygiene visits every six months. It offers both functional reliability and long-term maintenance ease, which is especially valuable for elderly or medically compromised patients. My patient shared that this treatment has truly changed his life, as he is now able to eat with confidence and smile naturally again.

Surgical procedure

Initial treatment consisted of systemic antibiotic therapy and the use of mouthwash to control the infection. Under local anesthesia, a full-thickness flap was elevated, and all remaining teeth were extracted. This was followed by alveoloplasty and the immediate placement of dental implants in a single surgical session, following the Straumann® implant placement protocol. Four Straumann® TLC SP SLActive® implants were placed at the following sites: 35 (∅ 3.75 mm RT, 10 mm), 36 (∅ 4.5 mm WT, 10 mm), 45 (∅ 3.3 mm RT, 10 mm), and 46 (∅ 4.5 mm WT, 10 mm) (Figs. 8-14).

After the three-month healing phase, a second-stage surgery was performed. Clinical evaluation at this stage revealed satisfactory soft tissue healing and successful osseointegration of all implants (Figs. 20-22).

Prosthetic procedure

Following confirmation of implant stability, we proceeded to the final prosthetic phase. The Angle Measurement Guide was used to assess the angulation of each implant. Healing abutments were then removed, and abutment height selection for the LOCATOR® system was performed using a periodontal probe. The selected LOCATOR® abutments were inserted into the implants, and radiographs were taken to confirm complete seating. Once verified, each abutment was torqued to 35 Ncm using the Straumann® Ratchet with Torque Control Device and the LOCATOR® Driver (Figs. 23,24).

A conventional impression was taken using a custom tray, ensuring adequate space in the tray to accommodate the height of the LOCATOR® impression copings. The copings were placed and pressed firmly onto each abutment (Figs. 25,26).

Impression material was syringed around the copings, and the loaded tray was seated. Once set, the tray was removed and the impression was sent to the laboratory, where a plaster model was poured (Figs. 27-30).

An optical scan was performed to aid in the design and fabrication of the final prosthesis. Metal frameworks, intended to provide strength and ensure long-term durability, were digitally planned as part of the process (Figs. 31-36).

The set-up was completed using the vertical dimension of occlusion (VDO) determined during clinical evaluation (Figs. 37-39).

The laboratory technician made a PMMA try-in for the fixed prosthesis. It was tested in the mouth with the black processing inserts in place to check that all LOCATOR FIXED® housings were properly positioned, and to assess the occlusion, esthetics, and phonetics (Figs. 40-43).

Fifteen weeks after surgery, fabrication of the final restoration, a resin-based hybrid prosthesis, was carried out and try-in was performed intraorally. Based on the clinical indication, green LOCATOR FIXED® inserts were selected, as they are recommended for cases with four implants per arch. The black processing inserts were removed, and the green inserts were carefully aligned and pressed firmly into the housings using the LOCATOR® Systems Core Tool until securely snapped into place (Figs. 44-50).

The patient has been followed for six months, showing favorable clinical outcomes, good prosthetic function, and overall treatment satisfaction (Figs. 51-54).