Mandibular Rehabilitation with a Bar-Supported Prosthesis on 4 Implants Using XGATE Products

Patient

A 72-year-old, non-smoking male presented to the clinic with complex dental issues in both the maxilla and mandible, as seen in the initial photographs and CBCT scan.

The remaining teeth were deemed non-restorable and required extraction.

Diagnosis and Treatment Planning

The 3D CBCT scan revealed previous endodontic treatments and chronic inflammatory periapical lesions associated with the remaining teeth.

The analysis of the residual bone volume in the posterior regions showed a sufficient amount of bone in both the bucco-lingual and apico-coronal dimensions to allow for dental implant placement.

In the anterior region (interforaminal area), the alveolar ridge was too narrow for implant insertion without bone modification. However, the basal bone provided adequate volume to anchor and stabilize the implants.

After careful analysis and risk assessment, a treatment plan based on the Full-Arch protocol was formulated:

• Extraction of the remaining teeth.
  Osteoplasty to reduce the alveolar crest would be performed prior to implant placement.

Selected implants XGATE Dental X3 Internal Hex:

• Anterior region: Ø3.3 × 13 mm
• Posterior regions: Ø3.75 × 13 mm

As the Full-arch protocol involves immediate loading, the surgical site preparation and implant placement technique needed to achieve a minimum insertion torque of 35 Ncm.

Treatment Summary

The first stage of the operation included:

• Extraction of the remaining teeth.
• Debridement of the extraction sockets.
• Alveolar crest reduction.

The photo below shows the surgical site after the osteoplasty. Following this, the osteotomies were prepared, and the implants were placed.

The implants were placed successfully, and four straight V-type multi-unit abutments (XGate Dental) with a 1 mm collar height were immediately seated. The implants were placed with an insertion torque of 45-50 Ncm, indicating excellent primary stability while remaining within safe clinical limits.

The prosthetic plan involved a screw-retained prosthesis supported by a cast cobalt-chrome bar (Toronto Bridge style) to ensure optimal load distribution on the implants.

During the impression phase, a difficulty arose. The clinician initially attempted to take the impression using the temporary abutments, which can sometimes also serve as impression transfers. However, these abutments were too short to remain adhered to the impression material, resulting in an unstable and inaccurate impression.

Consequently, it was decided to fabricate a custom resin tray to capture a precise impression, splinting the abutments together to ensure maximum accuracy during the impression procedure. This technique allowed for an accurate impression for the fabrication of the prosthesis.

Occlusion control passed successfully.

During this healing period, the underlying soft tissues remodeled as expected. To ensure a precise and comfortable fit to the new tissue contours, the prosthesis required a reline.

This was accomplished using an indirect relining technique:

1. An accurate impression of the soft tissue surface was taken using a low-viscosity (light-body) impression material.
2. In the laboratory, the internal surface of the prosthesis was adjusted based on this new impression.
3. A few hours later, the patient received the relined prosthesis, which now fit perfectly to the healed tissues.

Before proceeding with the maxillary rehabilitation, the clinician verified the health and stability of the soft tissues surrounding the mandibular implants.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGate Dental products, please contact us in any convenient way.

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