Objectives: An intercalary defect or free-end defect of a few teeth can be treated with an implant prosthetic. This report introduces an implant treatment with a fixed superstructure delivered to a maxillary edentulous patient who could not accept a removable denture because of a severe gagging reaction, with maintenance of the implant prosthesis for 10 years. Methods: A sixty-one-year-old man complained of a functional disorder with an old, poorly maintained complete denture in 2006. He had been struggling with gagging for a long time. Conventional protocols involve preparing a complete but temporary removable denture was required to determine the occlusal plane and alignment of the artificial teeth, but the patient did not want this. Therefore, we decided to install four implants and prepare a provisional fixed bridge to determine the occlusal indices. Following CT analysis, the implants were manually installed at the lateral incisor and second molar regions bilaterally in one surgical operation. Five months later, further surgery was performed to connect multiunit abutments to the implants. A prosthetic impression was taken at the multiunit abutment level, and a biteplate was used to obtain the occlusal plane and ideal 3-dimensional position of the superstructure. After making adjustments to the provisional superstructure, a final one-piece Pt-Au bridge with a hybrid ceramics–resin coating was delivered. All operations were carried under intravenous sedation. Results: The patient’s maxillary alveolar ridge had been resorbed vertically and horizontally and the buccal side was considerably compromised. For a long time, he had been unable to make continuous use of the complete denture, which covered the palate widely and elicited gagging. Dental CT revealed insufficient bone volume for vertical implant placement, thus a bone graft was required; however, no donor site was identified for posterior augmentation by sinus floor elevation. Therefore, bilateral posterior implants were placed and tilted along the mesial wall of the sinus cavities, to acquire initial stabilisation at 20 N/cm. Two anterior implants were also angled labially to establish the class I occlusion. The initial stability was 25 N/cm. Bilateral mandibular posterior recovery with dental implants and the occlusal plane and vertical dimension were determined by the Willis face method. The patient felt nauseous with the provisional bridge, thus the posterior parts of the bridge were not well maintained, although the patient insisted on continuing with it. Five years later, the patient noticed more frequent bleeding from the peri-implant crevicules. With the pa.ent’s understanding, we decided to remove the whole implants . Conclusion: Multiple tooth defects are often not suited to fixed prostheses on implants because occlusal or functional recovery can be difficult, with restricted implant positions and angulations in absorbed, compromised alveolar ridges and gingival recession. It was difficult for our patient to travel long distances to the hospital at the stated periods, particularly after the onset of respiratory disease, so it informed consent needed to address the predictable insufficiency of the prosthesis, and the increased risk of peri-implantitis. In reality, the patient was satisfied and had no complaints for 10-years, demonstrating that implants can restore function, aesthetics and quality of life, even if they have a relatively short life.

Gliederung: - Präoperative Planung und Vorbereitung der Schablonen - Implantationstechnik im zahnlosen Unterkiefer - Intraoperative Eingliederung eines konfektionierten Steges - Postoperative Anfertigung eines festsitzenden implantatgetragenen Zahnersatzes - Eingliederung des festsitzenden Zahnersatzes auf den drei Implantaten am Operationstag Inhalt: Im Beitrag wird die Implantation von drei enossalen Schraubenimplantaten und die direkt-postoperative Anfertigung eines festsitzenden Zahnersatzes im zahnlosen Unterkiefer vorgestellt. Nach eingehender Darstellung der Indikationsvoraussetzungen, Planungsgrundlagen und Erstellung der Planungshilfen in Form von unterschiedlichen chirurgischen Schablonen wird die Implantatlagervorbereitung und Implantation von drei enossalen Schraubenimplantaten im zahnlosen Unterkiefer demonstriert. Ausführlich ist hierfür die Festlegung der Implantationsorte zur direkt postoperativen Eingliederung eines konfektionierten Steges dargestellt. Ebenfalls wird ausführlich und detailgenau die Anfertigung eines festsitzenden Zahnersatzes zur direkt postoperativen Eingliederung vorgestellt. Die Funktionstüchtigkeit des Zahnersatzes wird abschließend durch eine kaufunktionelle Belastung demonstriert.,

Outline: - Surgical wound debridement - Sequestrotomy - Preparation of the soft-tissue bed - Plastic, tension-free, saliva-proof wound closure List of materials Basic surgical tool set: - Surgical blade - Preparation scissors - Pair of tweezers - Suture materials