Patient history:
Name: Claude - Age: 78 - Gender: male
Medical history : HTA ASA II
Dental history: loss of multiple teeth without being able to use a removable upper prosthesis due to the palatal torus, producing posterior lifting, leaving no occlusal support for feeding.
Reason for consultation: I want something fixed to be able to feed myself.
![](https://static.wixstatic.com/media/6b2364_edb0e72819904a87ab4bf18594a496a7~mv2.jpg/v1/fill/w_147,h_75,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_edb0e72819904a87ab4bf18594a496a7~mv2.jpg)
Diagnosis:
• Maxillary and mandibular partial edentulousness
• Periodontal diagnosis: Stage III chronic periodontitis, localized, Grade A.(Caton,2017)
Relevant clinical situations
• Fine Gingival Biotype.
• Collapse of the ridge Class II (Seibert,1983) Moderate (Allen,1985).
• Upper lip line: Tall smile.
• Ridge shape (Coscolla Rodriguez): U shape: Palatal and buccal faces in parallel position, provides a good "occlusal surface" and is the most favorable.
• Lekholm and Zarb (1985) Classification: Class C: Advanced anterior resorption of residual alveolar bone.
• Atwood Classification: Class V: Low well rounded in the anterior zone.- Class III: High well rounded in the right post zone.
![](https://static.wixstatic.com/media/6b2364_08d200049e2c42709cf7940f7523f1fa~mv2.jpg/v1/fill/w_147,h_84,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_08d200049e2c42709cf7940f7523f1fa~mv2.jpg)
![](https://static.wixstatic.com/media/6b2364_b225ab6617f04369bdb9c0ff7d0c246a~mv2.jpg/v1/fill/w_147,h_83,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_b225ab6617f04369bdb9c0ff7d0c246a~mv2.jpg)
![](https://static.wixstatic.com/media/6b2364_81eafa3efbed4e69a9dfa2a3f8a8271f~mv2.jpg/v1/fill/w_147,h_84,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_81eafa3efbed4e69a9dfa2a3f8a8271f~mv2.jpg)
![](https://static.wixstatic.com/media/6b2364_594f4b8a27304061893718bff034dd14~mv2.jpg/v1/fill/w_147,h_84,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_594f4b8a27304061893718bff034dd14~mv2.jpg)
treatment plan:
Multiple implants, All on Four technique with Neobiotech ISIII active implants + osseodensification with versah drills in posterior beds, ROG (Botis): Bone graft: non-resorbable xenograft (demineralized Bovine Bone without organic matrix) and Jason membrane stabilized with resorbable suture.
Implant with immediate load (temporal-definitive fixed) using upper prosthesis, installation of straight and angled pillars for temporary multiunic.
![](https://static.wixstatic.com/media/6b2364_c5251d5cb7984e55a523da31bb992a46~mv2.jpg/v1/fill/w_147,h_46,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_c5251d5cb7984e55a523da31bb992a46~mv2.jpg)
prosthetic duplicate and semi-strict surgical guide
![](https://static.wixstatic.com/media/6b2364_8cabbc76b3a24d9db12c9cb0cdd9ae7e~mv2.jpg/v1/fill/w_147,h_68,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_8cabbc76b3a24d9db12c9cb0cdd9ae7e~mv2.jpg)
![](https://static.wixstatic.com/media/6b2364_c1123cf0d7c2453a837670ee1138ccc0~mv2.jpg/v1/fill/w_147,h_103,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_c1123cf0d7c2453a837670ee1138ccc0~mv2.jpg)
![](https://static.wixstatic.com/media/6b2364_6bdac405b8ec42dbbacb345bc881b91b~mv2.jpg/v1/fill/w_147,h_120,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_6bdac405b8ec42dbbacb345bc881b91b~mv2.jpg)
definitive temporary prosthesis
![](https://static.wixstatic.com/media/6b2364_c6608d96e0d1448285838d819b939b08~mv2.png/v1/fill/w_49,h_25,al_c,q_85,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_c6608d96e0d1448285838d819b939b08~mv2.png)
![](https://static.wixstatic.com/media/6b2364_d3a731d7c9a54e0888274eed08db5606~mv2.jpg/v1/fill/w_147,h_92,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_d3a731d7c9a54e0888274eed08db5606~mv2.jpg)
![](https://static.wixstatic.com/media/6b2364_964ef52615e34d05b6166f2a9104ee70~mv2.jpg/v1/fill/w_147,h_76,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_964ef52615e34d05b6166f2a9104ee70~mv2.jpg)
Final hybrid prosthesis installed.
![](https://static.wixstatic.com/media/6b2364_bfa2aec383ac40ac928c898b0532b71d~mv2.jpg/v1/fill/w_147,h_81,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6b2364_bfa2aec383ac40ac928c898b0532b71d~mv2.jpg)
Amazing final results!! Thank you for sharing doctor!!