Juan Carlos Mejía Escalante

DDS, CES University.  Specialist in Dental Care for the Adult Patient, University of Antioquia. Medellín- Colombia.

Email: juancarlosmejia@une.net.co Medellin – Colombia Tel: (57-4) 448 48 47 – (57) 312 258 34 36

Andrés Mauricio Peña Quintero

DDS, Oral and Maxillofacial Surgeon CES University. Medellín- Colombia.

Ex-president and founder of the Colombian Association of Oral and Maxillofacial surgery, branch Medellín.

(This poster was awarded 4^th place in the Nobel Biocare World Tour 2008, Brazil)

Pictures and information can not be partially or fully publish with out the author’s permission.

Oral rehabilitation, using dental implants, in the fully edentulous patient who, for the previous several years has worn a total prosthesis, is a major challenge for the surgeon and the prosthodontist.  The use of bone grafts, sinus elevation and transportation of the mentoneano nerve has made many patients reluctant to accept oral treatment due to the high expense involved and the prolonged time of the treatment.  The potential disability resulting from the surgery, the possible risks and complications of the grafting procedures and the inability to use the prosthesis for extended periods of time causes many patients to believe that their dream of having a functional, fixed and aesthetic prosthesis is unobtainable.   With the advent of the Nobel Guide technology many advantages are evident making oral treatment possible on patients, who before where not immediate candidates for dental implants.  This technology allows for virtual surgery on the computer and a detail planning before the procedure is actually done on the real patient.  Thanks to the software, the possibility of shortening the surgical time and a more precise procedure is a very attractive value adde benefit for the professional and the patient.  Many visible advantages must be considerd  when a case is planed: The quickness of  the treatment; the low  morbidity of the procedures; and,  the lower cost involved  due to the lack of costly reconstruction steps.  The Nobel Guide software is a versatile tool for the treatment of the fully edentulous patient causing less nuisance because of the possibility of doing the surgery with local anesthesia and without flaps.

A 53 year old patient, fully edentulous, who has worn total prosthesis for more than 25 years.  This presents a severe alveolar atrophy which had been previosly denied for treatment with dental implant during several years.  The patient is not a candidate to undergo surgery with general anesthesia since she has had cardio respiratory arrest in 2 previous attempts due to a high sensitivity to anesthetic medications. 

Photos: 1. Pre surgical panoramic radiograph that shows alveolar atrophy. 2. Clinical occlusal view of the upper and lower jaw. 3. New adequate prosthesis with radiopaque marks for the CT scan. 4. Case planning in the procera software using Replace Select Nobel Biocare dental implants  5. Placement of the surgical guides in the mouth. 6. Implants in place and torque of the prosthesis. 7. Bar design. The bar surrounds the temporary titanium abutments passably. 8. Casted bar in a non precious metal with Ivoclar teeth in the Muffle. 8. Final Prothesis. 9. Prothesis in Mouth. 10. X-ray 3 months after surgery. 11. Patient before and after.

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Conclusions:

• Nobel Guide and the software Procera can make a dream come true to the fully edentulous patients with limited osseous conditions.  It can give the patient a chance to wear fixed dental prosthesis with minimum trauma, high predictability at a reasonable cost.

• Because of the simplicity of the technique for the patient and the rapidity of the procedure there is a high acceptance and satisfaction for the patient, recovering not only aesthetics but confidence and self esteem.   It also gives the patient the ability to recover with a complete functioning  masticatory status, giving back in some measure a better quality of life.

• In the mid-term with adequate treatment, the use of an acrylic fixed prosthesis around a cast passive structure over the titanium temporary abutments can ensure high aesthetics and a good resistant as a “temporary” final prosthesis.

• We present an alternative predictable technique, safe and economic for the functional reconstruction and aesthetic of the fully edentulous patient  to recover their self esteem and confidence with a high degree of satisfaction.