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Implantology sectIon

FULL ARCH iMPLANT

REHABiLiTATiON

POSiTiVE OUTCOME AFTER iNiTiAL SETBACK

Sachindeep Singh

Loss of teeth leads to continuous bone resorption, which in dental 3. Carrying out planned and predictable implant placement as
parlance is known as residual ridge resorption. The process is most surgical stent
rapid during the first six months, thereafter the bone resorption 4. In cases of immediate loads, the transition or converted denture
activity of the residual ridge continues throughout life, at a slower rate,
resulting in the removal of a large amount of jaw structure. Residual B. SURgiCAL
Ridge Resorption [RRR] is a chronic, progressive, irreversible, and 1. Fabrication of surgical stent: It is an essential tool in clinicians’ hands
disabling disease, probably of multifactorial origin. to achieve the best possible placement of implant according to the
Placement of dental implants has been shown to stop the residual prosthetic design.
ridge resorption in between the implants. Full Mouth Rehabilitation 2. Number and position of implant placement: Pre-implant planning
via implants thus becomes not only a functional comfort for the patient goes a long way in determining this accurately.
but also has therapeutic effect on the RRR. 3. Flap design and closure: It is essential to plan flap design to achieve
Ridge resorption leads to various clinical scenarios when it comes the desired aesthetic and functional goal. Also equally essential is
to bone available in height and width. A comprehensive classification the air-tight and tension-free closure for desirable surgical outcome.
is presented by Jao Carames where the edentulous situation is divided
into 5 classes starting from minimal resorption to maximum. C. PROSTHETiC PHASE
For success in Full Mouth Implant Rehabilitation, one needs 1. Inter arch space
meticulous planning and sequential steps to be able to achieve the final 2. Occlusal plane
result. 3. Antero-posterior positioning of anterior teeth
Goals of Full Mouth Implant Rehabilitation [FMIR] 4. Lip support
1. To stop the continuing residual ridge resorption 5. Smoot transition from implant platform to prosthetic platform
2. To give function and esthetics to the patient 6. Maintenance and hygiene simplicity.
3. To improve the life quality of the patient. Prosthetic phase can be very smooth if pre-implant and pre-
4. To have harmony between the implant-supported teeth and jaw prosthetic planning is meticulous …and is followed via surgical stents
musculature in the surgery.
5. To have better phonetics
CASE REPORT
STEPS iN FMiR A 65-year-old female had failing upper and lower bridges. We got her
For simplicity sake the case presented here is full arch edentulous case previous radiographs and did some rough planning for lower all on 4.
and steps are given accordingly. The steps can also be applied in partial (Figures 1, 2)
edentulous cases as well with some modifications. She then came a few months later and by that time she had lost
The basic preliminary steps needed for implant number and position her upper bridge. (Figures 3, 4). Now she was in a hurry and wanted
planning, prosthetic design, and post-operative care are as follows immediate loads. Upper and lower teeth set up was done (Figures 5, 6)
with fabrication of upper and lower dentures. The case fell under CCIV
A. PRE-iMPLANT PLANNiNg according to Carames classification.
1. Establishing Incisal plane
2. Establishing the occlusal plane Anterior – advanced resorption: height >8 mm and <12 mm; width
3. Establishing the vertical dimension >6 mm
4. Establishing correct phonetics and aesthetics Posterior – severe resorption: height <4-6mm or width <6 mm
All the above steps can be very easily established by fabricating the The case was planned for all on 4 with two tilted implants distally
best possible dentures for the patient. The art of denture fabrication and two straight in the center. The lower fabricated denture was
is taught at a very basic level in dental schools and is something all to be converted into a transitional fixed. The surgical sitting went
restorative dentists can achieve. accordingly, starting with teeth extraction (Figure 7) followed by
Denture also plays an important role in: flattening the bone platform (Figure 8). All on 4 Surgical guide was
1. Implant position planning secured to orient the tilted implants (Figure 9). The case was executed
2. Radiographic evaluation as radiographic stent with Straumann Neodent Aqua Implants (Figure 10).

30 Dental Practice i July-August 2023 i Vol 19 No 4