8 implants restoring the lower jaw

1. IMPLANT PLACEMENT
FOR AN IMPLANT SUPPORTED
FIXED PROSTHESES
Case report presented for learning
Performed by Dr.Manju John
Assisted by Dr.Pedram Gholami
Photographs by Dr.Mohd.Mohd. Jamal Assied
Instructor Dr.Fadi

2. INTRODUCTION
 A fixed restoration provides the psychological
advantage of acting and feeling similar to natural teeth.
 Fixed prosthesis need less repair and less
maintenance and often last the life of the implant
support.
 The contour of fixed restoration is less prone to food
entrapment. It also helps in posterior mandibular bone
gain

3. Patient History
 Name –A M G
 Age – 54 years- Non smoker
 Missing teeth – Completely edentulous
 Other - Smoker

4. Diagnosis & Study cast with wax up
facial view Maxillary occlusal view
Mandibular occlusal view Study cast with wax up

5. EVALUATION of OPG
Preoperative OPG

6. TOMOGRAM SCAN & SCHEMATIC ANALYSIS
Bone density in 33 region is 935 housefield units (D2 bone ),bone width at the crest
is 9.3 mm, bone length from crest of the ridge upto mental foramen is 17mm.
So3.8mm dia/ 12mm length implant chosen.

7. CONSENT FORM
 The patient should sign
this form before starting
the surgery to be aware
of the surgical
procedure and the
complications that might
happen.

8. TREATMENT PLAN
Treatment plan
 It was decided to place 8 implants in mandible thus
providing an implant supported fixed prostheses
 Total extraction of maxillary retained roots was done.
 Initially 8 implants in mandible to be placed.
 After soft tissue healing, implants to be placed in maxilla.
own.

9. SURGERY
 The surgery was performed on 14th of April 2014
under standard sterilization protocol.
 Before the surgery the patient was given
 1gm Amoxycillin(antibiotic) and ponstan forte(analgesic).
 Patient brushed his teeth with chlorhexidine paste.
 Local anesthesia lidocane 2% (1:80 000) used, buccal and lingual
infiltration done.

10. CRESTAL INCISION
Periosteal elevation doneNo:15 blade used for crestal incision

11. ELEVATED FLAP & FLATTENED CREST of RIDGE
Very thin alveolar bone exposed Flattening the crest of the ridge to get
more bone width

12. OSTEOTOMY DRILL
Bone ostotomy uing a sequence of
different sizes of drills.
Osteotomy site

13. IMPLANT - 3.8mm/12mm Biohorizon
Biohorizon implant 3.8mm diameter/ 12 mm length
implant

14. IMPLANT IN PLACE
Implant insertion Implant tightened with hand
rachet
Implant in position Cover screw placed

15. SSUTURE & APPLICATION OF GINGIGEL
single interrupted sutures given gingigel

16. POST OPERATIVE IOPA & OPG
8implants in position Implant in 33
region

17. POST OPERATIVE INSTRUCTIONS
 Ice pack was placed on the area after surgery and
patient was advised to keep it for one hour and stop
smoking for few days.
 Medicines –
 Antibiotic (Amoxicillin 500mg) + Anti-inflammatory &
Analgesic (ponaston forte 500) 3/day
 Gengigel 3/day for 3weeks
 Chlorohexidin 0.2% gel (Elugel) for 1 week followed by
Chlorehexidin 0.2% Mouth wash (Corsodyl) for 21days.
 Recall after 2 month .

18. UNCOVERY,IMPRESSION COPING INSERTION
and CUSTOM TRAY
for open tray technique
cover screws removed impression copings

19. CUSTOM TRAY TRIAL and IMPRESSION

20. RESTORATION

21. CONCLUSION
 The Primary advantage of an Implant supported Fixed
prosthesis is the elimination of cantilevers.
As a result, risk of uncemented restorations and occlusal
overload are reduced.
 An anterior Implant supported overdenture may
accelerate posterior bone loss, but an implant supported
fixed prostheses will maintain and helps the regeneration
of posterior bone in mandible.