Fully Guided and Minimally Invasive Implant Placement as the Basis for Effective Digital Fabrication of a Tapered-Crown Full-Arch Prosthesis
A 74-year-old male patient presented to the Department of Oral Medicine at the Goethe University in Frankfurt, Germany. The patient had been edentulous for 15 months and had been treated with a complete denture by students in the undergraduate program. During a recall appointment, the patient complained of poor retention of his maxillary complete denture. The prosthetic site consisted of a rigid and thick maxillary ridge with an undercut in the left posterior region. The prosthesis covered the entire palate and was dislodged by biting on solid foods such as apples. The patient did not have high esthetic expectations, but he did want improved chewing comfort and "fixed teeth".
Surgical classification
Complex
Prosthodontic classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 15
CME/CPD
25 hours
Purchase price
10
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General Risk Assessment
Patient-related Factors
| Oral hygiene | Good |
|---|---|
| Compliance | Good |
Patient-medical Factors
| Medical Fitness | Healthy, able to undergo planned anesthesia and surgical procedure (ASA I) |
|---|---|
| Medications | No medications that would negatively affect the surgical procedure and outcomes. |
| Radiation Treatment | None |
| Growth Status | Complete |
Site-related Factors
| Access | Adequate |
|---|---|
| Pathology near the implant site | None |
| Previous surgeries in planned implant site | No previous procedures. |
Surgical Classification
Surgical Complexity
| Timing of placement | Healed (Type IV) |
|---|---|
| Simultaneous or Staged grafting procedures | Implant placement without adjunctive procedures |
| Number of implants | > Three |
Anatomy
| Keratinized Tissue | Sufficient (>4 mm) |
|---|---|
| Soft Tissue Quality | No scars or inflammation |
| Proximity to vital anatomic structures | Minimal risk of involvement |
Prosthodontic Classification
Complicating Factors
| Biological | Screw-retained restorations with appropriate contours |
|---|---|
| Mechanical/Technical | Absence of contributing factors |
| Planned contour of tissue-fitting surfaces | Appropriate contours (hygienic - accessible for maintenance) |
Prosthesis Factors
| Prosthetic volume | Adequate. Space available for ideal anatomy of the restoration |
|---|---|
| Inter-occlusal space | Adequate. Capable to create an anatomically & functionally correct planned restoration |
Occlusal Factors
| Occlusal scheme | User-defined occlusal scheme achievable |
|---|---|
| Involvement in occlusion | Involvement |
| Occlusal parafunction | Absent |
Complexity
| Loading Protocol | Early/Conventional |
|---|---|
| Interim prosthesis | Tissue or interim implant supported |
| Number of implants | >2 (non-splinted) or ≥ 2 (splinted) |
| Timing of placement | Healed (Type IV) |
Esthetic Risk Assessment
Edentulous Esthetic Risk Assessment (removable)
| Facial Support | Desired tooth position provides sastifactory labial support |
|---|---|
| Labial Support | Flange provides required lip support |
| Upper Lip Length | Long upper lip (>20mm) |
| Buccal Corridor | Wide corridor |
| Smile Line | No display of the Maxillary ridge at full smile |
| Maxillomandibular Relationship | Class I |
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