The patient of 63 years old applied to the clinic with the problem of the insolvency of old orthopedic structures, as well as the reluctance and fatigue to use removable bugel prosthesis further.
After a complete examination and exclusion of common somatic diseases, the patient is offered varieties of orthopedic structures based on dental implants. Due to the long absence of teeth and using a removable denture, a vertical and horizontal defect appeared in the distal part of the lower jaw. The patient refused the proposed treatment (vertical and horizontal augmentation) because of the duration and high cost. After a full analysis, a collective decision was taken to apply the concept of "all on six" (All-on-6) and "all on four" (All-on-4).
The stages of treatment on the upper jaw:
1. After removal of the bridge constructions, under infiltration and tubular anesthesia, atraumatic extraction of teeth 11, 13, 15, 21, 22, 23 was performed.
2. A bed for implants in the area of teeth 11,13, 21, 23 was prepared without flap exfoliation with simultaneous implant placement 3.5: 13=2,4.0:13=2,4.5:10=2 (Osstem TSIII SA) with the torc reaching 30 NCM.
3. In the area of teeth 16 and 26, closed sinus lifting and inserted implants (up to 20 NCM) using bone-replacing material (Sure-oss) were performed. The wound was sutured with a horizontal mattress and interrupted sutures (monofilament 4.0).
4. An impression was taken from the level of implants (A silicone) without corrective mass. After the end of orthopedic manipulations, special gingiva formers with a width of 5.0 mm and a height of 5.0 were installed on the implants.
The stages of treatment on the lower jaw:
1. The teeth 35-45 were extracted from the lower jaw under infiltration and mandibular anesthesia with simultaneous installation of implants 4.0:10=2,4.0:13=2 (Osstem TSIII SA); implants in the area of teeth 35 and 45 are placed at an angle of 35 degrees and torc 35NCM.
2. Special multi-unit abutments were installed on the implants.
3. The wound sutured (monofilament 4.0) with horizontal mattress and interrupted sutures.
4. Impressions were taken from the level of implants, and special gingiva formers were also installed.
An hour after the surgery, the height of the central ratios of the teeth was determined.
On the third day of the surgery, solid acrylic bridge structures were installed. The healing proceeded without complications.
After 4 months, the patient received zirconium bridges on the upper jaw with zirconium abutments (cement fixation) and a zirconium bridge with screw fixation on the lower jaw.
The patient is satisfied with the result of the work.
Photo report of work
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