Case 48: All on 4 Maxillary implants+ Immediate loading+ Defintive Malo bridge

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Case 48: All on 4 Maxillary implants+ Immediate loading+ Defintive Malo bridge
Another case of an immediate loading All on 4 maxillary prosthesis and after 6 months went ahead with a malo bridge made of milled Ti frame with PFM crowns.

This patient had fixed prosthesis in the upper arch with multiple root caries which required extraction of all the maxillary arch teeth. The patient requested for an immediate denture or fixed prosthesis on the same day of extraction due to esthetic concerns.

Phase 1: Involved a diagnostic impression and mounting & articulation along with cast modification in the maxillary arch for the fabrication of an interim immediate acrylic denture. This denture is used as an index and used for splinting the impression and conversion of the provisional denture into a fixed prosthesis. The entire surgery was done under local anesthesia. Total extraction was carried out followed by placement of two axial implants in the maxillary anteriors and angulated implant in the 1.5 and 2.5 region. System of implant used for this case was Nobel active. Ofcourse, CBCT planning was carried out well in advance.
The provisional acrylic denture is used as an index to orient the position of the implant abutment emergence site by using addition silicone on the intaglio surface.
Once recorded, holes are created to connect the temporary abutment cylinders for denture conversion in the lab.
Converted denture was torqued to 15 ncm and occlusion assessed and adjusted. A nightguard is given for the maxillary arch.










Phase 2: After 6 months a definitive Malo bridge was fabricated. The steps are similar to a fabrication of any implant full arch prosthesis as we have discussed in previous cases in my blog.







This case was done by me at Parasu Dental Hospital, Chennai

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