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The existing denture was inserted with putty to mark the orientation This could have been a biomechanical mistake as it prematurely
and position of multi-unit abutments. (Figure 11) loaded the upper implants. 4 months post op the upper immediate
Impression posts were placed and picked up through holes created loaded denture had failed with the failure of 3 implants.
with the marked denture (Figure 12, 13). The denture was acrylised in This failure of implants was learning lesson and a setback. But we
the area of the hole, the ridge form converted to convex and delivered thought the case through and decided to go ahead with a different
after 24hrs. (Figures 14, 15, 16, 17) location of implant placement, namely both tuberisities. (Figure 29)
The patient now wanted the upper fixed too as she was having After waiting for 4 months the final upper hybrid prosthesis was
major issues with her retention and physiological comfort. The maxilla fabricated following usual steps namely Impressions (Figures 30, 31,
was completely resorbed with a huge bone defect in the 23-26 region as 32), Jig trial (Figure 33, 34) followed by teeth set up trial (Figure
shown in CBCT done with a radiographic stent (Figure 18). A regular 35) leading to final prosthesis (Figure 36, 37). The patient was very
approach of 2 tilted implants and 3 straight was adopted and executed satisfied with her smile (Figure 38).
successfully, bypassing the maxillary defect. (Figures 19, 20, 21) Her Final OPG (Figure 39).
Since the primary stability was good, the clinician decided to load
the denture, with patient’s insistence. Similar steps as with mandibular ConClusions
prosthesis were adopted, starting with impressions and then Full mouth rehabilitation with implants is a very predictable and
conversion. Everything went fine as seen in the OPG, and one implant successful treatment modality for edentulous patients. A bit of
was left unloaded. (Figures 22, 23, 24, 25) precaution is needed in the immediate loads when dealing with
The mandibular hybrid prothesis was processed 3 months later. compromised bone, both in quality and quantity as it can leads to
(Figures 26, 27, 28) complications like immediate or delayed failure.

Fig 2

Fig 1-2: 65-year-old female had failing upper and lower bridges. Initial planning for lower all on 4.

Fig 3-4: She then came a few months later and by that time she had Fig 4
lost her upper bridge

Fig 6
Fig 5-6: Upper and lower teeth set up was done with fabrication of upper and lower dentures

Dental Practice i July-August 2023 i Vol 19 No 4 31