CLINICAL CASE®
All-on-4treatment concept
Mandible – TiUltra™ & Xeal™
Dr. Philip M. Walton

Patient
78 years, female
Clinical situation
Failing mandibular dentition
Surgical solution
Full arch clearance + same day
rehabilitation with All-on-4® treatment
concept
Restorative solution
Immediate PMMA temporary
Definitive zirconia
Surgery dateJuly 2019
Total treatment time
18 months
Case courtesy of Phil Walton

2

“I hated my teeth since I was a teenager
and as far as I can remember they werefraught with problems – constantcavities, fillings, root canals, extractions.
The pain associated with my teeth andthe recurrent issues were a source ofstress.
When I lost my back lower teeth thedentist attempted to use a denture thatmade me gag, was ill-fitting anduncomfortable – I simply could not wear
it and as a result my chewing/function
was impacted.”

Photo courtesy of Phil Walton

Initial presentation

Initial presentation

Photos courtesy of Phil Walton

Day of surgery

Day of surgery

Photo courtesy of Phil Walton

Day of surgery

Clinical presentation
Photo courtesy of Phil Walton

Day of surgery

VDO measurement
Photo courtesy of Phil Walton

Day of surgery

Extraction therapy
Photo courtesy of Phil Walton

Day of surgery

Flap reflection
Photo courtesy of Phil Walton

Day of surgery

Aveolectomy
Photo courtesy of Phil Walton

Day of surgery

Aveolectomy
Photo courtesy of Phil Walton

Day of surgery

Implant insertion
Video courtesy of Phil Walton

Day of surgery

Implant insertion
Video courtesy of Phil Walton

Day of surgery

High insertion torquePhoto courtesy of Phil Walton

Day of surgery

Bone profiler
Videocourtesyof ofPhilWaltonVideocourtesy
PhilWaltonVideocourtesyof PhilWalton

Day of surgery

Implants placed
Photo courtesy of Phil Walton

Day of surgery

Multi-unit Abutment Xeal™
Photo courtesy of Phil Walton

Day of surgery

Multi-unit Abutments Xeal™
Photo courtesy of Phil Walton

Day of surgery

Impression Copings
Photo courtesy of Phil Walton

Day of surgery

PMMA prosthetic
Photo courtesy of Phil Walton

Day of surgery

TemporaryTemporary
Photo courtesy of Phil Walton

6-month impression

6-month impression

Photos courtesy of Phil Walton18 months

18 months

Photo courtesy of Phil Walton18 months

Photo courtesy of Phil Walton18 months

Photo courtesy of Phil Walton18 months

Photo courtesy of Phil Walton18 months

Zirconia final
Photo courtesy of Phil Walton18 months

Intaglio surface
Photo courtesy of Phil Walton18 months

Photo courtesy of Phil Walton18 months

Photo courtesy of Phil Walton18 months

Photo courtesy of Phil Walton18 months

Photos courtesy of Phil Walton

Case courtesy of Dr. Phil Walton

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