J Korean Acad Prosthodont.  2018 Oct;56(4):330-337. 10.4047/jkap.2018.56.4.330.

All-on-4 implant restoration with full-digital system preserving existing occlusion: A case report

• Kim KH
• Jeong SM
• Lee YC
• An XY
• Choi BH

• KMID: 2424034
• DOI: http://doi.org/10.4047/jkap.2018.56.4.330

Abstract

In edentulous patients, implant - supported fixed prosthesis treatment has been proved to be useful, but involves complex treatment process. On the other hand, in the modern dentistry, digital technology has been developed day by day and it has expanded its range to the implant restoration of edentulous patients. In this case, a digital system was used for all stages of diagnosis, surgery, design and fabrication of provisional implants fixed prosthesis restoration in 66-year-old mandibular edentulous patients. In the preoperative diagnosis stage, a provisional restoration was designed based on the mucosal scan using the intraoral scanner and the stable occlusion of prefabricated complete denture of the patient. After flapless implant surgery using the surgical guide, the prefabricated interim restoration was connected to the implant and used as immediate provisional restoration. The final restoration was designed and fabricated by transferring the vertical dimension and the centric relation of the provisional restoration with stable occlusion using digital technology. We report a simple protocol of implant treatment in edentulous patients by using digital techniques to preserve the patient's vertical dimension and occlusion.

Keyword

Edentulous; All-on-4 implant; 3D printer; Immediate interim prosthesis; Digital dentistry

MeSH Terms

Aged
Centric Relation
Dentistry
Denture, Complete
Diagnosis
Hand
Humans
Printing, Three-Dimensional
Prostheses and Implants
Vertical Dimension

Figure

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  Fig. 1 Pre-operation. (A) Frontal view without existing denture, (B) Frontal view with existing denture, (C) Panoramic radiograph.

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  Fig. 2 Direct scan of residual ridge. (A) Marking on residual ridge using radiopaque resin, (B) 3D scan image of residual ridge.

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  Fig. 3 Data of Occlusion. (A) Impression using denture, (B) Biting image, (C) Deletion of lower denture image.

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  Fig. 4 Merging CT image with scan file and Planning of implant placement. (A) Right, (B) Front, (C) Left.

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  Fig. 5 Surgical guide for flapless implantation.

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  Fig. 6 Design of interim prosthesis. (A) Frontal view, (B) Occlusion with antagonist jaw, (C) Occlusal view.

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  Fig. 7 Pre-fabrication of interim prosthesis. (A) Occlusal view, (B) Frontal view, (C) Inner surface.

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  Fig. 8 Flapless Implantation and Interim prosthesis connection. (A) Surgical guide, (B) Implantation, (C) Confirming of cylinder site using interim prosthesis, (D) Adhesion of interim prosthesis and cylinder using resin curing.

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  Fig. 9 Removing flange of interim prosthesis.

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  Fig. 10 Overlapping of scanfile of interim prosthesis and residual ridge. (A) Overlapping of scan files, (B) Confirming of implant site using interim prosthesis.

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  Fig. 11 Fabrication of framework. (A) Design of framework using occlusion of provisional prosthesis, (B) Intraoral check of framework, (C) Checking of cleansing space using dental floss.

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  Fig. 12 Fabrication of Final prosthesis. (A) Occlusal view, (B) Frontal view, (C) Right side (D) Left side.

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  Fig. 13 Delivery of Final prosthesis. (A) Intraoral photo, (B) Panoramic radiograph.

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