MALO CLINIC PROTOCOL IMMEDIATE-FUNCTION CONCEPT UPPER AND LOWER JAW REHABILITATION: A CLINICAL REPORT PURPOSE Rehabilitation case with an implant-supported rehabilitation with immediate function implants. CASE DESCRITION This clinical case refers to a 62-year-old female patient, with poor prognosis of the failing dentition and without systematic conditions. The patient visited the MALO CLINIC for an evaluation with the purpose of having a fixed rehabilitation. A clinical examination, including extra and intra oral photographs (Images 2-5) combined with a radiographic examination - orthopantomography (Image 1) and Cone Beam Computerized Tomography (CBCT) -, showed a resorbed maxilla with sinus pneumatisation, along with periodontally compromised remaining teeth. Also, pre-operative alginate impressions and bite registration were made. The treatment plan presented was the MALO CLINIC Protocol for both jaws, which allows a predictable immediate implant placement with associated immediate function and high aesthetics. RESULTS AND CONCLUSION This case is an example of the All-on-4 Surgical and Prosthetic Protocol, which allows a trained surgeon to successfully rehabilitate cases with bone defects and accentuated bone resorption with a fixed implant-supported rehabilitation. BEFORE AND AFTER PHOTOS & OPGs BEFORE & AFTER
1. Pre-Operative Orthopantomography General Bone Loss and Poor Prognosis of the Remaining Teeth. Unsatisfactory rehabilitation. 2. Extra-oral Frontal View (Rest) to Evaluate the OVD and Lip Support 3. Extra-oral Frontal View (Smile) to Evaluate the Smile Line and Intermaxillary Relationship
4. Intra-Oral Frontal View to Evaluate the Shape and Relationship Between the Arches, Size of the Maxilla, Molar Class and Interocclusal Space 5. Intra-Oral Frontal View to Evaluate the Shape and Relationship Between the Arches, Size of the Mandible, Molar Class and Interocclusal Space After complete teeth extraction and debris removal, a muco-periosteal flap was retracted allowing the identification of all anatomical limits along the process. Implants osteotomy was conducted following the drills sequence according to the bone density, aiming for an underpreparation protocol in order to achieve an adequate primary stability. The surgical procedure was performed according to the MALO CLINIC Protocol. In both jaws, two straight anterior implants and two tilted implants (NobelSpeedy Groovy RP, Nobel Biocare AB) were placed. The bone density was qualified as medium in both arches and the primary stability obtained was more than 50 N/cm in all implants. To the posterior angulated implants were adapted multiunit abutments of 30º 4 mm with 15 N/cm torque and to the straight anterior implants were adapted 2 mm multiunit abutments with 35 N/cm torque as recommended by the manufacture. Silk suture was used to stabilize the flap, immediately proceeding with the impressions. Once the impression set was removed, healing caps were placed (Nobel Biocare AB) and a post-operative orthopantomography was done (Image 6). 6. Post-Operative Orthopantomography MALO CLINIC EDUCATION CLINICAL CASE REPORT
On the surgery day, both upper and lower provisional acrylic prostheses with 10-teeth were adapted, fulfilling the esthetic and functional requirements. The provisional prosthesis must not present cantilevers to avoid excessive overloading during the osteointegration period. The inclination of the posterior implants depends on several factors, including the presence of infections and localization of major nerves and vessels. Consequently, the number of teeth of the prosthesis is determined by the position of the posterior implants. The occlusion was adjusted: minor contacts on the posterior teeth, incisal and canine guidance. 10 days after the surgery on the oral hygiene appointment control the sutures were removed (Images 7 and 8) and the occlusion checked again (Images 9 and 10). 7. and 8. Intra Oral View 10-Days Post-Operative 9. and 10. Intra Oral View of the All-Acrylic Provisional Bridges (10-Days Post- Operative)
11. and 12. Extra and Intra Oral View of the All-Acrylic Provisional Bridges (4-months Post-Operative) Clinical Team Surgical Procedures Paulo Malo, DDS, PhD (upper jaw); Armando Lopes, DDS, MSc* (lower jaw) Prosthodontic Procedures Pedro Estevão, DDS* *MALO CLINIC Lisbon, Surgery Department MALO CLINIC EDUCATION CLINICAL CASE REPORT