Treatment decision-making
The initial treatment decision-making was for a complete fixed
implant-supported prosthesis in the maxilla. Given the reduced size of
the maxilla and the severe bone resorption, 5 implants were placed
instead of 6, using a surgical template fabricated according to the
patient’s original prosthesis: 2 zygomatic implants on the left (Nobel®,
Zurich-Flughafen, Suisse), respectively 47mm regarding the first molar,
and 50mm regarding the canine), and 3 standard implants on the right
(Nobel®, Zurich-Flughafen, Suisse), respectively 2 implants (4.3 x 10mm)
regarding the first molar and the second premolar, and 1 implant (3.5 x
10mm) regarding the canine. The diverging axes were compensated using
30°-angulated multi-unit abutments (Nobel®, Zurich-Flughafen, Suisse).
Implant loading was performed using the patient’s initial complete
removable prosthesis converted into a fixed implant-supported bridge.
During the months required for osseointegration, oral hygiene
maintenance revealed too difficult for the patient. When reevaluating
the different clinical parameters, patient’s demand and indications for
different treatment options, we decided to change our initial treatment
plan and to implement an implant-retained bar-supported overdenture.
In the mandible, a complete removable denture was stabilized on the 2
existing symphysis implants using axial attachments (Locator Zimmer®
(Warsaw, Indiana)).