Scholar Case 3

ITI Scholar Centre:
University of Bern
School of Dental Medicine
Department of Prosthodontics
Chair: Prof. Dr. Regina Mericske-Stern

Title:
Implant-retained maxillary overdenture with immediate loading on 4 ITI implants connected with a bar

Introduction
A 62 years old male patient suffered from a car accident that caused lost of his remaining teeth in the maxilla. He was referred to the Department of Prosthodontics, School of Dental Medicine, University of Bern, by an insurance company for the fabrication of an implant supported maxillary overdenture.
Clinical and radiologic examination revealed a minimal sign of cleft palate which didn’t effect the placement of the implants. The patient reported a slight amount of air escape, but we couldn’t observe this.
Medically, the patient had high blood pressure, otherwise he was found to have no medical history.
The treatment planning of the surgical part comprised placement of 4 ITI full screw implants ( SLA-surface, 4.1 mm diameter, length > 8mm) well distributed in the anterior arch. The prosthetic part included maxillary overdenture with a horse shoe design, connected to a U-shaped bar. During the operation, after having checked that primary stability was excellent, we decided to implement immediate loading
The treatment outcome is highly satisfactory. Good retention is reached and the overdenture is removable which facilitates cleaning.

		1 Maxilla before implantation.

		2 Radiographic view of the prospective implant sites.

		3 Three 4.1 mm diameter implants of 12 mm length and one 4.1 mm diameter implant of 10 mm length, SLA- surface, were placed. After having checked that primary stability was excellent, we decided to implement immediate loading. The new synOcta transfer system was used.

		4 After the completion of the surgery, impression was taken immediately with synOcta impression caps.

		5 After impression, healing caps were used allowing to reposition the flap and maintain access to the implants.

		6 Cast of the maxilla with U-shapped gold bar.

		7 Occlusal view of the bar in the mouth 4 days after surgery.

		8 The old prothesis was adapted with soft relining material until the fabrication of a new horseshoe-designed overdenture was completed.

		9 This is the start for new overdenture fabrication: transfer copings were seated on octa abutments for a new final impression.

		10 Final impression.

		11 Occlusal view of the bite registration with the wax rime.

		12 Frontal view of the final wax set-up of maxillary overdenture in the articulator.

		13 To complete the final overdenture, the bar is positioned on the mastercast. View of the orientation index of tooth set up in relation to bar position.

		14 The dolder bar, U-shaped, was mounted to the octa abutments. The abutment screws are tightened using the SCS screwdriver with a minimal torque ( by hand ). After 3 months we will use a ratchet device with a tightening torque of 35N/cm for the abutments and 15N/cm for the screws.

		15 The internal (tissue) surface of the overdenture showing the retentive elements of the bar.

		16 Occlusal view of the final maxillary overdentures with a cast metal framework.

		17 Final radiography with the bar in situ two weeks after surgerywhen treatment was completed. The first implant in right maxilla was placed in slightly more distal position (better bone quality and better bar length).

		18 Frontal view of the patient with final overdenture.

		19 Cleaning instructions with special device.