Case 149 | The Award 2017 | Egypt
Dr. Amr Elkhadem / Ahmed Kotb / Marian Ahmed Roshdy / Huda Fakhry Saeed / Omar M. Mahfouz
Full mouth rehabilitation case using minimally invasive guided implant placement.
The patient is a 45 years old female with few remaining teeth and class II skeletal relationship. the patient had a deep bite with slight facial collapse
Due to prolonged tooth loss in the lower arch noticeable vertical bone loss can be seen
the case was planned on bluesky plan 3 and flapless guided surgery was done
in the second stage custom implant abutments were designed on dental wings software to correct the anatomically compromised implant sites. the patient was restored with a full anatomical CAD CAM multi layer zirconium bridge.
Preoperative photos for the patient with few remaining anterior teeth and deep bite
Diagnostic wax up of the case Trial waxup for closure of the diastema Wax up is duplicated with acrylic and barium sulfate mixture. the radio-opaque scan template is made with holes at the suggested prosthetic centers and border serrations for software superimposition Implant planning for the lower arch. the implant site at #32 has relatively thin alveolar crest. the implant is planned for slight sub crestal position and expansion simulation was done. The implant at 36 is severely lingually inclined to avoid sublingual perforation. simulation for angular correction was planned Implant planning for the upper arch Because the waxing at the right side was not ideal, virtual setting was done and implant were planned in #15 and # 17 The final design for the maxillary and mandibular guides Implants were placed in flapless approach except in number 36. a small incision was made to avoid laceration of the soft tissue due to narrow band of keratinized mucosa Closed tray impressions for the lower arch Designing custom zirconium abutments on ti base models. Note how lingually inclined is the implant at #36 Upper and lower virtual on the DWOS for full anatomical design Full CAD CAM design
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