Immediate Loading of Four Narrow-Diameter One-Piece Implants in the Edentulous Mandible
A 63-year-old female patient presented at the School of Dental Medicine of the University of Bern, Switzerland (zmk Bern) with the goal of improving her dental appearance and finding relief from the persistent pain and discomfort in her teeth and gums. While recognizing the need for surgical interventions, she aimed to minimize the number of surgeries required. The patient suffered from obesity and mild hypertension, treated with amlodipine and valsartan under the care of her physician. She lived independently and appeared to be active and cognitively fit. Financial limitations for dental treatment were present.
Surgical classification
Complex
Prosthodontic classification
Complex
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 15
CME/CPD
0.25 hours
Purchase price
10
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General Risk Assessment
Patient-related Factors
| Oral hygiene | Poor |
|---|---|
| Compliance | Adequate |
Patient-medical Factors
| Medical Fitness | Moderately compromised health, but can undergo planned anesthesia and surgical procedure (ASA II to ASA III) |
|---|---|
| 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 | Moderate 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 | Compromised. Can be resolved without adjunctive therapy |
Occlusal Factors
| Occlusal scheme | User-defined occlusal scheme achievable |
|---|---|
| Involvement in occlusion | Involvement |
| Occlusal parafunction | Absent |
Complexity
| Loading Protocol | Immediate |
|---|---|
| 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 |
| Maxillomandibular Relationship | Class I |
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