Treatment decision-making
The initial treatment decision-making was for a complete fixed implant-supported prosthesis in the maxilla. Given the reduced size of the maxilla and the severe bone resorption, 5 implants were placed instead of 6, using a surgical template fabricated according to the patient’s original prosthesis: 2 zygomatic implants on the left (Nobel®, Zurich-Flughafen, Suisse), respectively 47mm regarding the first molar, and 50mm regarding the canine), and 3 standard implants on the right (Nobel®, Zurich-Flughafen, Suisse), respectively 2 implants (4.3 x 10mm) regarding the first molar and the second premolar, and 1 implant (3.5 x 10mm) regarding the canine. The diverging axes were compensated using 30°-angulated multi-unit abutments (Nobel®, Zurich-Flughafen, Suisse). Implant loading was performed using the patient’s initial complete removable prosthesis converted into a fixed implant-supported bridge. During the months required for osseointegration, oral hygiene maintenance revealed too difficult for the patient. When reevaluating the different clinical parameters, patient’s demand and indications for different treatment options, we decided to change our initial treatment plan and to implement an implant-retained bar-supported overdenture.
In the mandible, a complete removable denture was stabilized on the 2 existing symphysis implants using axial attachments (Locator Zimmer® (Warsaw, Indiana)).