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QUARTER 1 | 2014 | CERECDOCTORS.COM | 49
possible, and followed by final restora-
tion with a full-arch implant-supported
zirconia hybrid reconstruction.
A second treatment phase was planned
to address the partial edentulism in the
mandible by placing implants to support
single-tooth implant-supported crowns.
This plan was to be confirmed or modi-
fied after cone beam computerized tomo-
graphic evaluation. This case examplewill
highlight the procedure in themaxilla.
The first step of the treatment was to
fabricate a removable partial denture,
replacing the missing and broken-down
teeth in the maxilla based on a function-
ally, phonetically and esthetically verified
tooth set-up. This partial denture was
duplicated in radio-opaque acrylic and
used as radiographic template. A cone
beam CT radiographic evaluation was
performed with the Sirona Orthophos
XG3D CBCT machine. The DICOM files
were exported into the Anatomage soft-
ware. Six maxillary implants, along with
three surgical guide stabilizing anchor
pins, were planned in the Invivo Anato-
mage software (Fig. 3). In addition, the
maxillary model was sent to Anatomage
inSanJose, Calif., for the fabricationof the
surgical guide (Fig. 4).
Fig. 5: Clinical view after initial extractions
Fig. 6: Seated and stabilized surgical guide
Fig. 7: Implant placement and connection
of multiunit abutments
Fig. 8: Insertion of open tray impression
copings for indirect denture conversion
Fig. 9: Immediate (one day post-op)
loading via a screw-retained
provisional hybrid denture
Fig. 10: Final Prettau Zirconia implant-
retained hybrid reconstruction
Fig. 11: Occlusal view of the final screw-
retained hybrid reconstruction
Fig. 12: Final postoperative panoramic
radiograph
Fig. 13: Pre-operative facial view
Fig. 14: Facial view, one day post-surgery
Fig. 15: Final facial view
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