Page 56 - DP Vol 20 No 3

Implant dentIstry sectIon

Fig 9: The prosthesis connected to the cylinders before being finished. Fig 10: Provisional prosthesis control after 7 days.

Fig 11: Scans for the realization of the final prosthesis.

the two arches (upper with fixed prosthesis on implants, lower using a sequence of cutters for guided surgery. These were one-piece
edentulous). The removable lower denture was scanned and used for implants with integrated pre-angled MUAs.
maxillomandibular relationship scans. After the implant insertion, the metal structure for positioning
Based on the intraoral scans, the laboratory (Dental Art, Saronno) the implants was removed by unscrewing it. Metal cylinders were
created a radiological template with radiopaque markers. connected to the implants, and the temporary prosthesis was
The patient underwent a CBCT examination (Newtom Giano HR, positioned by attaching it to the primary structure with screws. The
Newtom) with the template positioned in the mouth, followed by a metal cylinders were connected to the temporary prosthesis using dual
new intraoral scan. cement, and the prosthesis was then removed for finishing.
Starting from the radiographic examination and intraoral scans, At the end of the procedure, the primary structure held by the fixation
the positioning of four implants (Fixo, Oxy Implants, Biomec) was pins was removed, the area was sutured, and the temporary prosthesis
planned, along with the creation of a fixed prosthesis with immediate was positioned. The patient was instructed to avoid excessive occlusal
loading in PMMA with metal reinforcement. All pre-surgical planning loads by following an appropriate diet and was rechecked at 1, 4, and
phases were managed through intraoral scans, with no analogue 8 weeks. After 3 months, the temporary prosthesis was removed, and
impressions used. intraoral scanning was used to create a definitive monolithic zirconia
The implant positioning template was created with a stackable prosthesis reinforced by a titanium bar.
structure. A printed resin bottom base, reinforced by a metal portion The prosthesis was completed in two appointments: the first for
with threaded holes, was connected to a printed resin structure a bar test with a PMMA specimen for occlusal verification, and the
designed to achieve the maxillomandibular position and guide the second for the delivery of the finished prosthesis. Compared to the
placement of the first template. Threaded fixation pins were positioned, freehand analog procedure used for positioning the upper implants
and after verifying the stability of the template, the upper structure for years before, the digital workflow with implant positioning guided by
positioning was removed, leaving the primary portion of the template a stackable modular template allowed excellent control of the implant
fixed by the pins. positions, effective management of peri-implant tissues, and simplified
Thanks to the accessibility of the tissues, flaps were prepared to occlusal management.
preserve the existing keratinized tissue. Subsequently, a rigid metal The use of an open metal structure for the implant positioning
structure for the placement of the implants was screwed onto the lower phase made tissue management more effective compared to traditional
base. The four implants (Fixo, Oxy Implants, Biomec) were positioned templates. Additionally, defining the maxillomandibular position by

54 Dental Practice I May-June 2024 I Vol 20 No 3