Full-Arch Implant-Supported Fixed Dental Prosthesis

The patient presented complaining of a loose mandibular denture with bilateral posterior open bite affecting his ability to function; and the maxillary denture having poor aesthetics. He reported being a motivational speaker and was very conscious while speaking and smiling. He wanted to regain his confidence and improve overall function and aesthetics. In addition, his diet was restricted to diced and soft foods, and wanted to improve his diet and general health.

The patient had a complex medical history (immunodeficient), therefore, meticulous oral hygiene was imperative. Appropriate treatment options were presented and informed consent was obtained. The patient had elected to proceed with a complete maxillary denture and a mandibular implant-supported fixed dental prosthesis. The diagnostic phase involved maxillary and mandibular diagnostic set-up and fabrication of a radiographic guide for dual-scan CBCT acquisition and implant planning.

Four Ø4x13mm implants were immediately placed following mandibular clearance and alveolectomy. Good primary stability was achieved with an insertion torque of >35 Ncm and ISQ >70. The implants were immediately loaded with a metal-acrylic provisional prosthesis for 3 months. After osseointegration, adjustments were made to the provisional prosthesis to ensure optimal speech, mastication and access to oral hygiene.

A milled titanium bar was designed according to the provisional prosthesis and a definitive maxillary clear processed-base complete denture and a titanium-acrylic implant-supported fixed dental prosthesis with Phonares (IvoclarVivadent) denture teeth were fabricated. The patient reported superior function including eating corn on the cob, increased confidence, and improved smile and facial aesthetics.