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.

Objectives: From analysis of the literature, the absence of epithelial proliferation and adaptive capacity dice determines the ability of tissues to regenerate. When planning a clinical experiment, we suggested the presence of gap (≥ 8.0mm) between the implant and the bone in the area of the implant platform (factor of epithelial proliferation). The aim of this study was to evaluate the efficiency of the rooting implant method in terms of preserving alveolar bone volume. Methods: Sixty patients were studied in 2013–2016 (male–female ratio 1:2; mean age 43 ± 5 years). Various parameters were explored using specialist devices such as a physiodispenser. The implant position was determined using a Navigator YUK-MTM (patent number UА 85876), and bone architecture was visualised using modified radiovisiographs with cadmium–zinc–tellurium single-crystal filters. Implants with an internal connection of depth 3.5mm and length 10.0mm were used. Patients were divided into two groups. The treatment group (n = 30) underwent root implant surgery, with the application of bone thickening gel-like material on the back of the circular platform implant. When rooting compression of this layer reached a thickness of 0.5mm as displayed on the navigational device, the operation was stopped. The back implant surface and surrounding area were covered with a 10.0-mm nanostructured membrane. The control group (n = 30) underwent standard dental implantation. Surgery was carried out by a single operator under standardised conditions, and all patients were examined by a standard procedure. The degree of vertical bone resorption after 6 and 12 months was used to indicate bone atrophy. Results: After 6 months, the treatment group gave unexpected result: in sixteen cases, there was vertical restoration of bone tissue in the near-implant area. In nine, excess bone tissue, freeing the cap implant, was removed. In ten cases, the initial bone level was preserved at the near-implant area. Changes in gums and problems with subsequent prosthetics occurred significantly less often. In four cases, bone was resorbed approximately 1.5mm from the lingual and vestibular sides of the alveolar crest. After 12 months, the patients in the treatment group showed no bone loss. In 22 patients in the control group (73%), X-ray and visual examination revealed varying degrees of proliferation of soft-tissue defect in the area of ​​the periosteum (which can be affected by watering), whereby defects covered the implants irregularly. Radiovisiographic images of both groups revealed 46 cases with wedge-shaped defects filled with gingival tissue (the fine bone structure was not visible using standard methods). The navigation device gave an accuracy of implant positioning 2.0 ± 0.5 minutes (at a deviation of less than 25 arcminutes) and 1.0±0.5 minutes (at a deviation of less than 5 minutes). Linear positioning accuracy was 0.50 ± 0.05mm (at the implant moving up to 10mm). Conclusion: It is possible to predict the impact of pathogenic factors in dental implantation and safely achieve prosthetic restoration of anatomical structures for patients and their organs. Bone regenerative capacity is preserved and bone remodelling is stabilised in the area of ​​the periosteum. The proposed method of visualising thin bone structure makes it possible to assess the impact of surgery on the size and nature of the defect, and predict reparative capabilities and the effectiveness of rehabilitation. The clinical potential of this medical navigation includes dentistry and medical robotic systems. This study opened up further possibilities for optimising the surgical process, predicting the impact of pathogenic factors in dental implants, and eliminating it.