CHIEF COMPLAINT:
Patient would like a “fixed tooth” in the area of the central upper right incisor. Despite having a removable prosthesis with multiple elements, and several teeth missing in the upper jaw, the patient only wanted a fixed rehabilitation for that specific tooth.
DIAGNOSIS:
Male patient, 48 years of age, carrying an acrylic upper prosthesis for longer than two decades. Several teeth were missing from the upper jaw, and the occlusal plane was uneven. A wide edentulous gap was present on the location of tooth 2.1, with extrusion of antagonist teeth. The alveolar ridge was compatible with dental implant placement.
TREATMENT PLAN:
The suggested treatment consisted in placing an implant in the place of tooth 2.1, for subsequent rehabilitation with a metal-ceramic crown. By special request from the patient, the existing removable acrylic prosthesis would be kept.
TREATMENT NOTES:
An imaging guide was prepared, to be used in the TAC scan, supporting the virtual planning of an implant on the location of tooth 2.1. A surgical guide was designed, based on the virtual planning, to improve accuracy in implant placement. After two months of osseointegration, a healing screw was installed in the second surgical stage. Once the peri-implant tissue maturation was completed, a dental impression was done with an open-tray technique, in order to produce a provisional screw-down restoration. This allowed the emergence profile architecture to be developed during the next eight weeks. The definitive impression was achieved by individualization of the transfer piece. The lab produced an individualized anatomical abutment and a metal-ceramic crown. Rehabilitation was completed with final placement, and adjustment of the removable prosthesis.