Indication5, Case 4 | ITI CENTER

Edentulous mandible

Jason Gillespie, DDS
Prosthodontics, Baylor College of Dentistry-TAMUS
Private Practice, San Antonio, Texas

Eduardo R. Lorenzana, DDS, MS
Periodontics, Baylor College of Dentistry-TAMUS
Private Practice, San Antonio, Texas

	A fully edentulous Caucasian male presented with a 20-year history of an ill-fitting mandibular denture. Pre-operative occlusal photograph of edentuluous mandibular arch.

	Pre-operative panoramic radiograph showing adequate vertical bone height and favorable quality of bone.

	Wax-up of new maxillary and mandibular dentures following impressions and centric relation records.

	Duplicate of new mandibular denture in clear acrylic resin. Pre-measured gutta percha points have been placed on the buccal surfaces of the mandibular teeth to aid in the location of the mental foramen in preparation of surgical stent fabrication.

	Panoramic radiographs showing the maxillary and mandibular radiographic guides in place. The implants were treatment planned for placement at least 5 mm anterior to the mental foramina to avoid the anterior loop of the inferior alveolar nerve.

	Initial flap reflection demonstrating osseous architecture at the time of implant placement surgery.

	ITI depth gauges demonstrating parallelism and final placement depth of the implants.

	Prepared osteotomy sites just prior to implant placement.

	(2) ITI SLA-surface 4.1 x 10 mm implants (shown) were placed in the distal osteotomy sites. (2) ITI SLA-surface 4.1 x 12 mm implants were placed in the mesial osteotomy sites.

	Buccal view of final implant placement with ITI cover screws in place. Note full submersion of SLA surface and similar depth of placement (important for ease of bar fabrication).

	Occlusal view of final placement showing proper implant distribution to allow space for retentive clip.

	Occlusal view of final placement through the surgical guide stent. This result demonstrates the importance of treatment planning and communication.

	2 weeks healing.

	Delivery of interim denture relieved internally to allow room for undisturbed implant osseointegration.

	At 6 weeks, (4) ITI octabutments were torqued to 35 Ncm using the ITI torque wrench, as demonstrated. Note finger positioning and tightening using only the torque meter for leverage to prevent over/undertorquing.

	Occlusal view of ITI octa abutments torqued to 35 Ncm after 6 weeks of undisturbed healing.

	Impression copings stabilized with GC resin prior to impression.

	Internal (tissue) surface of impression showing pick-up impression copings.

	View of working cast with octa abutment and soft tissue analogs.

	Wax-up of oval retaining bar on non-octa (non-rotational) gold cylinders with distal ERA attachments. The final bar will be cast to the gold cylinders. Note large reservoir to facilitate a quality casting.

	Occlusal view of final gold retaining bar. Passive fit was ensured prior to final placement. The SCS screws securing the bar to the octa abutments were torqued to 15 Ncm.

	A new working cast was fabricated for final denture fabrication. This view shows the gold bar in place with acrylic denture teeth retained within an overlying silicone index. This is used to verify adequate space for the denture base and the retentive elements.

	The intaglio (tissue) surface of the final processed denture showing the retentive elements: anterior clip and distal ERA attachments.

	Occlusal view of final mandibular prosthesis.

	Frontal view of final maxillary and mandibular prostheses. Restorative result is retentive, retrievable, and cleansable.