Scholar Case 4

Laboratory work:
Mr. Harunori MORITA, DT
Hello Dental Laboratory, Tokyo, Japan

Title:
Single standing implants of multiple unit restorations

Introduction
A 61 year old male patient, presenting with a distal extension situation in the maxilla and posterior missing teeth in the mandible, underwent consultation for implant replacement of missing teeth with a single, free-standing solution. Problems included posterior bite collapse, deep overbite, root caries of many teeth, diastemas of anterior teeth, unfavorable crown-root ratio in several premolars, periodontal disease, and bruxism.

Initially, clinical and radiographic assessment was carried out and a diagnostic-wax-up, was performed and discussed with the patient. The diagnostic wax-up was then duplicated twice, first to fabricate a surgical template, and second to fabricate provisional restorations. The treatment planning of the surgical phase included extraction of eight teeth and placement of eleven ITI implants including immediate placement and sinus floor elevation utilizing the ITI Osteotome system. The prosthetic treatment plan included full coverage crowns on all remaining permanent teeth and implants. The six premolar implants were restored with transversal screw-retained crowns. The maxillary molars were restored with metal ceramic cemented crowns. The single standing implant supported prostheses gave the patient both stable function and esthetics .

		1 Initial radiograph showing numerous hopeless teeth.

		2 Radiographic evaluation after placement of eleven implants. Both maxillary molar sites were lifted 2mm to 3mm using the ITI Osteotome system and two implants were placed bilaterally. The premolars were extracted and implants were immediately placed.

		3 Final impression of the maxilla 12 weeks after placement.

		4 Final impression of the mandible 12 weeks after placement.

		5 Buccal view on the cast; Right posterior maxilla. The synOcta TS abutments were used on premolars, and the synOcta 15 degree angled abutments were used on molars.

		6 Right posterior maxilla Premolars were restored with transversal screw-retained crowns. Molars were restored with connected metal ceramic cemented crowns.

		7 Left posterior maxilla TS abutments were used on premolars, and Solid abutments were used on molars.

		8 Left posterior maxilla Premolars were restored with transversal screw-retained crowns. Molars were restored with connected metal ceramic cemented crowns.

		9 Occlusal view of the right posterior mandible TS abutments were used on premolars, and a solid abutment was used on first molar.

		10 Occlusal view of the final prosthesis on the cast Premolars were restored by transversal screw-retained crowns. First molar was restored with metal ceramic cemented crowns.

		11 & 12 The palatal view and the lingual view of the two superstructures clearly demonstrate the advantage of the transverse screw retention design. No occlusal screw access channels interfere with functional occlusal morphology and esthetics or with structural requirements inherent to porcelain-fused-to-metal technology.

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		13 & 14 Metal ceramic cemented crowns on the maxillary molars and first molar in mandible.

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		15 Occlusal view of the final maxillary prosthesis.

		16 Occlusal view of the final mandibular prosthesis.

		17, 18 & 19 Final frontal view of the maxillary and mandibular prostheses in the mouth.

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		20 Panoramic radiograph taken six months after restoration.