Carico immediato totale inferiore e
Marisa came to our office already wearing prostheses, both for the upper arch and for the lower arch: an upper overdenture on telescopic caps and an incongruous removable prosthesis badly relined below.
After years, Marisa’s prostheses were no longer congruent with her tissues and her maintenance had become rather difficult both in terms of cleaning and retention, having to make up for it daily through adhesive pastes. Nonetheless, the discomfort of the lower right teeth was important, due to a desperate prosthetic-periodontal situation. All this resulted in a strong aesthetic and psychological discomfort.
Fig. 1 The initial situation and the old prostheses, now incongruous.
Fig. 2 A three-dimensional reconstruction in frontal view. The significant atrophy of both the maxillary bone and the mandible is appreciated.
Fig. 3 The three-dimensional reconstruction in sagittal view. The mandible does not have enough bone for implant rehabilitation in the left hemiarch.
Fig. 4 The orthopanoramic performed on the first visit shows the superification of the mandibular nerve.
The ortohpanoramic and 3D CT performed in Fisioeuropa on the first visit highlighted severe atrophy of the lower left hemiarch: looking closely at the three-dimensional reconstruction, you will appreciate the important atrophy with bone thicknesses of less than 8 mm. Furthermore, the inferior alveolar nerve was superficial, which led to daily discomfort caused by the mucous support of the prosthesis.
The careful analysis of the case made it possible to build a surgical-prosthetic rehabilitation project that would allow the maintenance of the residual elements of the upper arch, still able to withstand a load.
In agreement with Marisa, we therefore opted for a hybrid solution for the upper arch through an implant-retained overdenture (→ find out more), and for a total implant-prosthetic rehabilitation of the Toronto Bridge type (→ find out more) for the lower arch.
From the CT we appreciated the low vestibular-lingual thickness of the lower bone which made us protrude for reduced diameter implants (3i Implant Innovation 3.25 mm in diameter x 13 mm in length).
On the day of the surgery, Marisa, under sedation and local anesthesia, underwent the extraction of the elements of the lower arch and the placement of five implants. The conditions of the upper jawbone, on the other hand, allowed the insertion of two implants, sufficient to support the prosthesis through attachments called “locators”.
Fig. 5 3D reconstruction after implant placement.
The following day, we delivered the prosthesis screwed onto the lower arch and after about 5 months the new upper overdenture with support both on the residual elements and on the implants with locator connection.
We were able to load the lower implants immediately because they were joined together by a 4 mm titanium bar laser welded to the abutments; on the upper side, however, the implants must wait about 5 months for them to be osseo integrated, otherwise the daily “putting on and taking off” of the prosthesis would have created micro-movements that would have led to implant failure.
Fig. 6 The control overview carried out on the day of delivery.
Fig. 7 Five months after surgery, this is what Marisa’s new prostheses looked like.
Marisa’s story shows how even the most difficult cases can be solved in a minimally invasive and fast way, with a certain perspective of duration over time: the case was carried out in 2014 and, to date, in 2020, the patient has no discomfort, not incurring bone loss. As for maintenance, Ms. Marisa only had to replace the Teflon gaskets of the locator attachments twice and she continues to visit my studio to carry out professional hygiene three times a year.
Don’t forget to watch the video of this case, here on my YouTube channel, where you will find many other testimonies.
PROF. GIUSEPPE BIANCO
I am a clinician who has been working 10 hours a day for 20 years, since 1999 I have placed about 11,000 implants.
WHERE TO FIND ME
Via dell’umanesimo 308
00144 Rome (RM)
(0039) 06 591 0674