In exchange, the anterior maxilla can be restored with pontics fabricated with esthetics in mind, without the use of implants. Fig 6-1b Drill holes at the planned implant positions. A CT or CBCT scan is then performed on the patient while he or she bites down. The thermoplastic foil, which had been prepared in advance, was tried in. Fig 6-6f Implants following exposure, with the teeth still in situ. Fig 6-12v Palatal incision made for implant exposure. It is a highly effective surgical procedure, enabling full prosthetic rehabilitation of the posterior maxilla to be achieved. Although the edentulous maxillary model used in the present study was equivalent to the American College of Prosthodontists Type A jaw , factors such as residual ridge morphology, palatal depth, and the presence or absence of palatal tori may have affected the results [28, 29]. Fig 6-12k Clinical situation at the time of suture removal. Fig 6-2c Stabilization screws driven into the palate. over, the maxilla and mandible present different anatomical and functional challenges related to their arch morphology, resorptive patterns, quantity and quality of the bone, presence of anatomical structure, and biomechanics.3 When a clinician is planning the rehabilitation of an edentulous patient, he/she If analysis of the CT scan images or the situation at the time of implant placement shows that the anatomical structure of the maxillary bone is not suitable for implants at all the planned locations, the described procedure leaves the option of selecting the most favorable sites. Fig 6-9d Implants placed into the definitive cast. Facial esthetics of a completely edentulous patient may be enhanced by a removable prosthesis (RP), especially in the maxilla. Fig 6-11p Palatal incision on the left side. Bar connector restoration on six implants. Fig 6-12p Virtual implant placement in the SimPlant program. Fig 6-3f Milled non-noble alloy bar connector. The condition of the prosthesis is also satisfactory (Fig 6-6j). The impression for the prosthetic restoration was taken once the correct positioning of the impression copings was checked on the radiograph (Fig 6-11u). One retained tooth, barely visible. Following the CT and panoramic radiograph analysis, the implant positions were established according to prosthetic aspects and taken into account in a custom-made template (Fig 6-5a). Bone augmentation was performed with a mixture of Bio-Oss and bone chips, not only on the labial/buccal but also the palatal side (Fig 6-7f). This staggered placement also ensured better distribution of the masticatory forces over the prosthetic superstructure. In this sort of situation, it is an advantage if a few posterior teeth can continue to carry most of the load during the healing period, at least, and if a sufficient number of long implants can be inserted with primary stability. Moreover, a stable bone situation is apparent from the follow-up panoramic radiograph taken after 5 years (Fig 6-6k). The future is bright for management of the edentulous maxilla. Fig 6-7h Angled abutments to correct the inclination of the implants. Fig 6-6i Bar connector after 5 years of functional use. to the maxillary sinus and combined with conventional implants in the anterior maxilla for the implant-supported rehabilitation of the edentulous maxilla. Any structure resembling a bent bow or an arc. Fig 6-3k Panoramic radiograph taken after 4 years in functional use. Bio-Gide (Geistlich) membranes were used to cover the augmentation. mean percent reduction in mandibular ridge height in edentulous patients Ravasini & Marinello used 3 titanium alloy provisional implants (Ti-6Al-4V) in the interforaminal area of an edentulous jaw, and 4 implants of conventional diameter (Branemark MK II, Nobel Biocare, CA, USA) were left submerged for the healing period. Since the dimensions of the bone in the posterior maxilla were still sufficient to anchor implants with primary stability, implant placement was performed in the same session as sinus elevation (Fig 6-11c). Fig 6-12m 3D reconstruction after augmentation. Usually, the patient for edentulous implant treatment has already been fitted with a complete prosthesis. The distal locking attachments hold the palateless denture securely in place (Fig 6-6h). Fig 6-2b The template is stabilized by the mandibular dentition. Conversely, no significant inter-operator differences were observed in errors in the intraoral scanning of either the left … 2.Exposure and long-term provisional restoration. An occlusion rim was also made out of putty to ensure exact positioning of the template (Fig 6-9f). Sinus floor elevation, implant placement and lateral augmentation. An average of four to six implants also is used to support bar overdentures. 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