CLINICAL CASE

Rehabilitationof a young patientwith a severely
degraded dentition

Ana Ferro
PortugalAna Ferro

PatientMale, 23 years old, healthy, smoker
Clinical situation
Poor oral health. Severe deterioration in the maxilla, andof the molar teeth in the mandible. Remaining teeth show
no sign of periodontal loss and mobility.
Surgical solution
Maxilla: All-on-4® treatment concept withNobelParallel CC implants
Mandible: Extraction of all molar teeth. Implant surgery
6 months after extraction: tooth 3.6 and 4.6“The high implant and prosthetic survivalrates of the All-on-4® treatment concept
makes it a safe and predictable surgicalprotocol from both the clinician‘s and thepatient‘s point of view. Clinicians should
adopt this treatment concept in their daily
practice to avoid demanding and timeconsuming additional surgeries.”

Restorative solution
Provisional: Malo clinic all-acrylic provisional bridge with
Temporary Snap Coping Multi-unit Plus
Final: NobelProcera implant bridge, Kulzer Pala Premiumteeth and artificial gingiva
Surgery date
October 2017
Total treatment time
Immediate delivery of all-acrylic provisional bridge,10-day post-operative control
Case courtesy of Dr. Ana Ferro

2/11

Initial clinicalsituation

Surgicalprocedure

Restorative
procedure

OutcomeCourtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

The orthopantomogram (OPG) of the maxilla shows a poor prognosis and severe oral impairment.
The large granulomas associated with most of the upper teeth will leave extended bone defects in the maxilla.
In the mandible, a good preservation of dentition is visible from pre-molar to pre-molar.
Case courtesy of Dr. Ana Ferro

3/11

Initial clinicalsituation

Surgicalprocedure

Restorative
procedure

Courtesy of Dr. Ana Ferro

OutcomeCourtesy of Dr. Ana Ferro

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Severe tooth decay and absence of prosthetic space,especially in the posterior sectors.

Courtesy of Dr. Ana Ferro

Bite evaluation.

Case courtesy of Dr. Ana Ferro

4/11

Initial clinicalsituation

SurgicalprocedureCourtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

Bone reduction was necessary to makeprosthetic space for the NobelProcera
bar and the bridge with false gingiva toultimately enhance the functional andesthetic results.

Restorative
procedure

OutcomeCourtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

The flap was elevated so the anatomical references,
nasal fossa and sinus external wall, were visible.
The All-on-4 Guide was used to insert the distal
implants in the arch with an accurate angle.

Courtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

The Multi-unit Aligning Instrument used toidentify the angulation of the Multi-unit
Abutment and simplifies the identificationof screw hole trajectory avoiding facially
protruding screws.
Case courtesy of Dr. Ana Ferro

5/11

Initial clinicalsituation

Surgicalprocedure

Restorative
procedure

OutcomeCourtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

Courtesy of Dr. Ana Ferro

OPG showing an optimized implant distribution, with all abutments and Healing Caps in position.
Due to the medium density of bone, bicortical anchorage was not necessary.
Case courtesy of Dr. Ana Ferro

6/11

Initial clinicalsituation

Surgicalprocedure

Restorative
procedure

Courtesy of Dr. Ana Ferro

OutcomeCourtesy of Dr. Ana Ferro

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Titanium Healing Caps in position over the abutments to shape
the soft- tissue. The 5 mm high Healing Caps were used becauseof the patient’s high soft-tissue volume.

Courtesy of Dr. Ana Ferro

Frontal view of the all-acrylic provisional bridge.

Case courtesy of Dr. Ana Ferro

7/11Initial clinicalsituation

Surgicalprocedure

Restorative
procedure

Courtesy of Dr. Ana Ferro

OutcomeCourtesy of Dr. Ana Ferro

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Maxilla healing 10-day post-operative.
Abutments are cleaned and checked for loosening.

Courtesy of Dr. Ana Ferro

Intra-oral view 10-day post-operative.

Case courtesy of Dr. Ana Ferro

8/11

Initial clinicalsituation

Surgicalprocedure

Courtesy of Dr. Ana Ferro

Restorative
procedure

Courtesy of Dr. Ana Ferro

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OutcomeCourtesy of Dr. Ana Ferro

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X-ray after 4 months

Case courtesy of Dr. Ana Ferro

9/11

Initial clinicalsituation

Surgicalprocedure

Restorative
procedure

Courtesy of Dr. Ana Ferro

OutcomeCourtesy of Dr. Ana Ferro

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Before and after 30 days

Case courtesy of Dr. Ana Ferro

10/11

Case courtesy of Dr. Ana Ferro“The All-on-4® treatment concept is a team approach. I would like to thankmy MALO CLINIC colleagues involved in treating our patient: Ana Abadia fromOral Hygiene Department, Dr. João Botto from Oral Surgery Department,Dr. Raquel Lucas and Dr. Rodrigo Gonzalez from Prosthodontic Department
and Helena Alexandre from MALO CLINIC Ceramics Laboratory.”

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