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Introduction
Dental implants are considered one of the best alternatives for replacing lost teeth, restoring both aesthetics and function. However, the waiting time to activate them is often a disadvantage. This is why we seek faster, more comfortable techniques for dental implant rehabilitation that provide satisfactory results for the patient.
Immediate loading protocols allow implants to be subjected to masticatory forces within the first 48 hours of their surgical placement, reducing waiting time, the number of surgical interventions, and increasing patients' overall well-being. An additional advantage is that we avoid the use of removable prostheses during the osteointegration process of the dental implants.
Case Presentation
A 69-year-old woman, whose reason for consultation is: “I want to get my teeth,” visits the Master's program in Oral-Facial Prosthetics and Occlusion at the Complutense University of Madrid. She is an ASA II patient with no contraindications for dental implant treatment. The patient is cooperative, and her treatment expectations are high as she wants fixed teeth.
Upon intraoral examination, we observe the presence of only tooth 2.3 in the maxilla, which has grade 3 mobility and periodontal involvement of the mandibular teeth.
Radiographic and CBCT studies show the degree of maxillary resorption.
Case Planning
For treatment planning, a complete prosthesis was made to serve as a provisional. By duplicating it with acrylic resin, we obtained a radiographic guide and a try-in with the teeth at occlusion by trimming the vestibular flange. This way, we could define both the aesthetics and functionality of the patient's prosthesis.
During the try-in, the distance between the maxillary ridge and the position of the teeth was observed; therefore, it was decided to perform a new try-in with a posterior crossbite to reduce the overhang of the prosthesis, especially in the second quadrant.
Once the type of prosthesis was defined, we proceeded to carry out a prosthetically guided surgical planning for 6 Biomimetic Ocean CC implants (Avinent), with 2 parallel in the anterior region (4.5x8mm), 2 intermediate angulated distally (3.5x11.5mm), and 2 pterygoid implants (3.5x11.5mm).
The placement of the implants was done avoiding the maxillary sinuses since the patient did not want to undergo sinus lift techniques to place dental implants at that level.
The implants were placed using a surgical guide designed by Avinent, based on the second try-in, which was fixed with pins prior to raising the full-thickness flap. Once the bone crest was exposed, we repositioned the guide to proceed with the drilling.
For the placement of the pterygoid implants, only the pilot drill was guided due to the length of the guided surgical drills.
The duplicate of the try-in was used to verify the proper emergence of the implants with parallelization pins.
Six Biomimetic Ocean CC implants were placed along with 4 straight transepithelium pillars on the anterior and posterior implants. On the intermediate implants, transepithelium pillars with a 17º angulation were placed to correct the inclination.
The position of the implants was captured with a photogrammetry system before suturing the flap (this way, it is possible to observe the correct settlement of the receivers on the pillars) and an intraoral scan was performed to record the soft tissues after suturing.
The immediate loading was installed before 24 hours, using only 5 of the 6 implants because the pterygoid implant in the first quadrant did not achieve adequate initial stability.
Follow-ups were conducted at 4, 7, and 14 days post-surgery to confirm that the tissues and the prosthesis were in good condition. The patient reported comfort, as well as a high degree of aesthetic and functional satisfaction.
After 4 months of immediate loading, we performed the second stage of the implant in position 1.7, waited 3 weeks for soft tissue healing, and took digital impressions to register the soft tissues and the position of the implants with scanning bodies. At the next appointment, we selected the color, FRI digital, conducted a try-in, and adjusted the functional and aesthetic parameters for the fabrication of the definitive prosthesis.
The dentoalveolar prosthesis is composed of a titanium structure and a multi-layer monolithic zirconia superstructure with an aesthetic finish.
Observe the good lip support, as well as adequate aesthetics and a high degree of satisfaction from the patient.
CONCLUSION:
Prior planning based on the type of final prosthetic rehabilitation required by our patient is essential to achieve predictable results and minimize complications during the osteointegration period in immediate loading treatments.
