Tilted Implants for a Mandibular Hybrid Prosthesis
This case demonstrates the use of tilted implants and angled abutments to support an immediate fixed provisional hybrid restoration on 4 implants.
A 61-year-old male presented with this chief complaint: "I know I am losing my teeth and now is the best time for me to get the treatment." He cited age, economics, and probable future problems. He also was concerned about esthetics. The dental history included a long process of periodontal treatment, including 2 major surgeries; the medical history was unremarkable.
The maxillary and mandibular dentition was hopeless due to bone loss and the periodontal condition. The patient did not want any kind of removable prosthesis, and fi xed restorations would require replacement of teeth and gingival contour. Due to the extensive bone loss, we selected a hybrid prosthesis with a dentureteeth and acrylic design with a cast or milled bar as a substructure. Although the patient could have received an immediate provisional for the maxillary and mandibular arch at the same appointment, he elected to have only the mandibular arch treated.
Because of inadequate bone superior to the inferior alveolar nerve and posterior to the mental foramen, tilted implants and angled abutments were indicated for the right and left most distal implants. This would increase the A-P spread (see Sidebar), allow longer implants for more support, and eliminate the need for bone grafting. The 2 anterior implants would be placed vertically to receive straight abutments. On the day of surgery, the teeth would be removed, implants placed, and an immediate provisional fi xed prosthesis delivered.
The case was set up for the same procedure as an immediate denture delivery with the denture converted to a fi xed provisional restoration after implant placement.
The patient's vertical occlusion was recorded before teeth extraction. A mark was made on the patient's nose and chin, and a record of this distance was noted with the teeth together and by marking a tongue blade.
The following photo essay describes the steps taken in this case.