Indication 9, Case 2 | ITI CENTER

Extended edentulous in both jaws

Daniel Hess, Dr. med. dent
St. Gallen / Switzerland
Alwin Schönenberger CDT,
Glattbrugg/Switzerland

	Panoramic radiograph of a12 years old female patient suffering from multiple congenitally missing teeth. The following teeth are absent: 15, 12, 22, 24, 25, 37, 35, 45, 47.

	Occlusal view of the maxilla after completion of the orthodontic treatment phase. The canines have been moved into the position of the lateral incisors. The edentulous gaps in the premolar areas correspond to premolar units and are going to be treated by implants. Extraction of deciduous teeth has been recently performed.

	Occlusal view of the mandible after extraction of teeth 75 and 85. The first molar teeth can now be moved mesially to allow adequate edentulous spaces for premolar units. At this point in time, the patient is 18 years old.

	Clinical situation after successful implant placement in the upper jaw. For aesthetic reasons, the implant shoulders have been placed slightly submucosally.

	Mandibular implants prior to abutment fixation. Because conventional orthodontic techniques didn't allow adequate alignment of teeth 36 and 46, the implants are going to be fitted with long-term provisional restorations to serve as anchorage for additional orthodontic movements (mesialisation of teeth 36 and 46).

	Final restorations of the upper jaw prior to cementation. For biomechanical considerations, the two adjacent units 24 and 25 are connected to each other.

	The finished single crowns 35 and 45 will be screw-retained. They are characterised by minimal metal margins and a flat emergence profile.

	Right lateral view at completion of therapy. The artificial crowns integrate harmoniously in the natural dentition.

	Final view of the patient's left. Open embrasures between 24 and 25 provide access for inter-implant oral hygiene.

	Harmonious dental arch in the maxilla. The absence of any occlusal screws contributes to improved mechanical properties of the FPDs.

	The screw-access canals of crown 35 and 45 were closed with composite. Replacement of missing second molars wasn't performed due to practical and economic considerations.

	The two year follow-up periapical radiograph of implant site 15 shows stable peri-implant tissues.

	The two year follow-up periapical radiograph of implant sites 24 and 25 documents good marginal fidelity..

	Two year follow-up periapical radiograph of implant site 35. The implant axis corresponds perfectly to the long axis of the adjacent teeth.

	The two year follow-up periapical radiograph of implant site 45 shows excellent tissue integration of the 12 mm full-body screw. Note the adequate final position of the molar tooth.