A woman with an advanced periodontal disease came to the office to rehabilitate the upper full arch where several teeth present high mobility due to a horizontal bone lost. The patient doesn´t presented medical records of interest, nor did she smoke. After taking pictures, an intraoral scanner, CBCT and radiographs, a digital protocol was applied to study the case and the possible solutions were presented to the patient.

The patient chose a scalloped denture instead of a hybrid denture. So, a more complex approach was used in order to get a more balanced harmony between the pink and white part of the smile. Mucogingival techniques were utilized to boost the biotype and compensate for the lost bone.

With a surgical guide the implants were placed immediately after the teeth extractions and loaded simultaneously in the same morning. While polishing and finishing the temporary restoration, CTGs were harvested and tunneled to improve the esthetic result. An implant placed too buccally on 14 position was retrieved the same day. Later on, a sinus lift procedure was executed in order to place an implant on 26 position.

Six months later follow up

Eight months later a digital impression with PIC dental® system was registered and Trios ® scanner were used to scan the provisional, the antagonist, occlusion and a specific scan of the soft tissues was added. All scan data and the PiC file® were imported in Exocad® and the final prosthesis framework was designed.

CAD/CAM cobalt chrome structure was manufactured and after a framework try-in, the final prosthesis was screwed.

Follow-ups showed a perfect adaptation of the prosthesis with a bone crest stable around the implant necks.

Dr. Ramón Gómez Meda