P. Maló1, C. Vidal2, C. Almeida2, I. Festas2, J. Nunes2, M. De Araújo Nobre3
1DDS, PhD, Oral Surgery Department; Maló Clinic Lisbon, Portugal
2DDS, Prosthodontic Department; Maló Clinic Lisbon, Portugal
3RDH, MSc Epi, Research and Development Department; Maló Clinic Lisbon, Portugal
Female patient, aged 65, attended the private practice (Maló Clinic Lisbon, Portugal) complaining about her present rehabilitation with removable prostheses associated with diminished masticatory capability and esthetic appearance. Her main goal was to obtain
an upper and lower implant-supported fixed rehabilitation. After careful clinical and radiographic examination it was proposed to rehabilitate the upper and lower jaws according to the All-on-4 Concept (Figures 1-3). In the same surgical procedure, 2 zygomatic implants with 40 mm and 45 mm length (Nobel Biocare AB) were inserted in the posterior region and 2 standard maxillary implants (NobelSpeedy Groovy 4×13 mm RP, Nobel Biocare AB) were inserted in the anterior region of the maxilla, following the All-on-4 Hybrid (Nobel Biocare AB) protocol6. All implants achieved an insertion torque above 50N/cm which allowed immediate provisionalization (Figures 4-6). In the lower jaw, 2 implants were placed on the 4th quadrant, one distally tilted implant (NobelSpeedy Groovy RP 4x13mm, Nobel Biocare) and one axial implant (NobelSpeedy Groovy NP 3,3x13mm, Nobel Biocare)10 followed by their respective rehabilitation with screw-retained acrylic provisional crowns replacing crowns #43 to #46 (Figures 5, 6). In order to correct the occlusal plan and considering the previous extensive fillings, endodontic treatments, reinforced glass fiber posts (D.T. Light-Post Bisco Inc.; Schaumburg, USA) and provisional crowns (Heraeus Kulzer Premium Linie, Heraeus Kulzer GmbH&Co., Wasserbutg, Germany) were performed in the teeth #34 to #36. A maintenance protocol with post-operative after 2, 4 and 6 months were performed, and in the absence of signs or symptoms of peri-implant pathology, the final rehabilitation was scheduled. Taking into consideration the age, the biomechanical advantages and the patient’s aesthetic concerns, a MaloClinic Ceramic Bridge (individual Procera crowns, Zirconia copings and Nobel Rondo Zirconia Ceramic; Nobel Biocare AB) cemented onto a CAD/CAM fabricated Titanium framework (Nobel Biocare AB) with pink acrylic resin (PallaXpress Ultra, Heraeus Kulzer GmbH) was performed in the maxilla. In the mandible, a screw-retained metal-ceramic fixed partial denture was performed over the 4th quadrant implants replacing crowns #43 to #46, and individual metal-ceramic crowns were luted with GC Fuji Plus (GC, América, Inc.) to the abutments #34 to #36 (Figures 7-12). The patient was kept on a six month recall plan, and both rehabilitations remained stable through a complete follow-up period of 3 years.