Four straight Straumann® screw-retained abutments (angulation 0°, Ø 4.6 mm, gingiva height 2.5 mm) were inserted and hand-tightened. The gold copings for screw-retained abutments (Ø 4.6 mm, height 5.5 mm) were placed on the abutments. The two sites were then sutured with non-absorbable nylon sutures (Figs. 6 - 7).
Holes were drilled in the removable full mandibular denture so that the denture would fit tightly without any interference with the copings (Figs. 8 - 9). A reline impression was taken directly on these copings using a fast-setting, addition-curing silicone (Fig. 10). The copings and abutments were then removed and replaced by healing abutments with the same emergence profile as the abutments (Fig. 11).
The U-shaped Dolder bar (macro) was fabricated in the laboratory by welding the bar onto the copings (Fig. 12). Retentive elements were placed on the inner aspect of the full denture (Fig. 13).
Less than 24 hours after implant insertion and fabrication of the bar construction, the abutments were screwed onto the four implants with a torque of 15 Ncm. This was done without causing the implants to move (Fig. 14) or any other symptoms. The bar was screwed (Fig. 15), and the fit was checked with intraoral radiographs. The full mandibular denture could then be inserted with good retention and in correct occlusion. Healing was uneventful (Fig. 16) and the sutures were removed after seven days. The patient's subsequent clinical progress was also free of complications. During the check-up, which took place two months after implant insertion, the abutments were tightened to 35 Ncm and the bar to 15 Ncm (Figs. 17 - 18).