Placed implant-supported ceramic dental prostheses

According to the X-ray, the implants were not in a single plane (their parallelism was disrupted), which could complicate prosthetics with a one-piece restoration; however, with coordinated work between the dentist and the dental technician, there is a good chance of achieving a positive result.

In addition, the patient’s medical history includes diabetes mellitus. Therefore, taking into account the patient’s wishes and her medical history, the dentist proposed the following treatment plan:

Place one additional Straumann dental implant in the area of tooth 1.6
Remove the bridge abutment teeth 1.4 and 1.7
Remove teeth 4.1, 3.1, 3.2 and 3.3 due to first- and second-degree mobility
Perform all surgical procedures simultaneously, i.e. in a single visit
Use original i-System prosthetic components for the restoration
Use a mock-up model in two stages to determine the prosthetic plane and parallelism
Carry out the restoration with a one-piece zirconium dioxide prosthesis
Reinforce the prosthesis with a titanium bar.

After consulting a periodontist, the patient nevertheless decided to remove the lower-jaw teeth, given the high risk of tooth loss and, consequently, the risk of needing a new prosthesis for the lower jaw.

The prosthetic components for the original i-System implant system were replaced with components from the manufacturer Bicon (USA) because of the fairly long delivery time (from 4 weeks) reported by the company’s representative. Moreover, the cost of these materials ultimately turned out to be lower.

        STAGE 3
        
Periodontist consultationThe periodontist examined the oral cavity and reviewed the X-ray images. She then advised the patient in detail on the timeline, cost and prognosis of the treatment.

        STAGE 4
        
Tooth extractionTo avoid losing time and money, the patient asked the dentist to return to the original treatment plan and remove teeth 4.1, 3.1, 3.2 and 3.3. The extractions were carried out in a single visit.

        STAGE 6
        
Remaking the mock-up modelThe second model was made with the titanium bar, all the parallels were aligned, and the teeth were enlarged at the patient’s request.

        STAGE 7
        
Permanent prostheticsThe patient wore the model for a few days, checking it for comfort and aesthetics, after which the dentist obtained consent for permanent prosthetics. In a single visit, the dentist removed the mock-up model and fitted two one-piece zirconium dioxide prostheses reinforced with titanium bars.