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44 | cerecdoctors.com | quarter 4 | 2013
The final restorative treatment was
initiated two months after implant
placement surgery and consisted of
attachment of locator abutments to the
implants and fabrication of an implant-
supported overdenture.
Case Example 2:
Mini-Implant-supported guide
This patient is an 87-year-old female with
a longstanding history of complete eden-
tulisml. The initial clinical and panoramic
radiographic evaluation (Figs. 12-13)
revealed moderate alveolar ridge atrophy
in the maxilla and very severe alveolar
ridge atrophy in the mandible resulting in
ill-fitting and non-retentive maxillary and
mandibular full dentures. The patient had
completely stopped wearing her mandib-
ular denture and had been told by two
other clinicians that implant therapy was
not possible in the mandible due to lack
of bone structure. A treatment plan was
devised to treat the maxilla with a new,
conventional full denture and to place two
transitional mini-implants followed by two
mandibular dental implants in two sepa-
rate surgical procedures in themandible to
support amandibular overdenture.
This patient had a relatively new set of
maxillary and mandibular full dentures
fabricated recently, so the first step of
the treatment was to verify that these
dentures were functionally, phonetically
and esthetically acceptable and to dupli-
cate the mandibular denture in radio-
opaque acrylic so it could be used as a
radiographic template (Fig. 14). The first
surgical procedure was performed under
local anesthesiaandconsistedof theplace-
ment of two mini-implants (miniMark 2.3
X 10 mm Locator implants with 4 mm
cuff height) (Fig. 15) in sites #24 and #25
via a flapless non-guided approach (Fig.
16). The patient’s mandibular denture
was then immediately attached to the
mini-implants with Locator housings via
a chairside hard acrylic pick-up (Fig. 17).
This provided the patient with immediate
| | | B o lt c h i
12 13
14 15 16
17 18
19
20
Fig. 12: Fully edentulous mandible with
severe alveolar ridge atrophy
Fig. 13: Preoperative panoramic radio-
graph revealing severe mandibular
atrophy
Fig. 14: Radio-opaque acrylic duplicate
of mandibular denture
Fig. 15: MiniMark Locator mini-implant
Fig. 16: Flapless placement of two mini-
implants
Fig. 17: Immediate loading ofmini-implants
Fig. 18: Attachment of duplicate denture
to mini-implants
Fig. 19: Attachment of duplicate denture
to SiCat biteplate
Fig. 20: Radiographic template attached
to mini-implants for CBCT scan
evaluation