Case Summary 🔎

Patient Information

• Age/Sex: 51-year-old Male

• Systemic Condition: History of Hypertension and under medication

Clinical Findings

• Tooth Site: Mandible

• Oral examination: #43 with Grade 3 mobility

• Diagnosis: Chronic periodontitis

Clinical Summary

The patient presents with a fully edentulous mandibular arch, except for the mandibular right canine (#43), which exhibits Grade 3 mobility. In the maxilla, a six-unit anterior bridge prosthesis is in place, and implant placement has been performed in both right and left posterior region. A full arch prosthetic rehabilitation is planned for the edentulous mandible.

Treatment Plan 

• Extraction of #43

• Placement of 8 implants in the mandible using Neo NaviGuide for guided surgery

• Final restoration with Zirconia crowns

Conclusion

In this case, a fully edentulous mandible was rehabilitated using the Neo NaviGuide system for the placement of 8 implants, followed by guide bone regeneration(GBR). Definitive prosthetic rehabilitation was successfully completed 8 months post-surgery. The patient demonstrated a stable outcome with good function and prognosis over an 7 year follow up.

Case Presentation

1️⃣ Pre-Op

• The pre-operative panoramic radiograph and intraoral photograph show a fully edentulous mandibular arch, except for #43.

• #43 exhibits severe mobility (Grade 3) and significant bone loss. Generalized alveolar ridge resorption is evident, indicating the treatment for full-arch implant-supported rehabilitation for function and esthetic restoration.

2️⃣ Treatment Plan

• #43 extraction and Implant placement using CMI implant on #34, #35, #36, #37, #44, #45, #46, #47

• Neo NaviGuide fabrication

• Neo NaviGuide drilling

3️⃣ Surgery - Full Arch Rehabilitation

• The Neo NaviGuide was placed in the mouth. The gingiva at the surgical site is removed using Tissue punch for flapless surgery.

• Initial drilling is performed to assess bone density and ensure accurate positioning for implant placement.

• To ensure a safe and precise surgery, the guide is stabilized using vertical anchors. The vertical anchors are placed in the bone at positions #35 and #45 are fixed to the appropriate depth and path using a torque ratchet.

• Step by step drilling is performed while assessing bone density. Bone particles collected during drilling can be used to autogenous bone.

• Based on the bone density, cortical tapping is performed in dense cortical bone to achieve maximum BIC and optimal fixation.

• CMI IS-III Active 4.0*10mm implant was placed in the area of #34.

• Connecting in fixture type vertical anchors to the implants at #34 and #44 to stabilize the Neo NaviGuide.

• Step by step drilling is possible through the stabilized guide fixed with vertical anchors. CMI IS-III Active 5.5*8.5mm implant was placed in the area of #47. CMI IS-III Active 5.0*6.0m implant was placed in the area of #37.

• A total of 8 implants were placed at #34, #35, #36, #37, #44, #45, #46 and #47.

• An incision is made at the surgical site where the ridge is narrow and requires bone grafting.

• Bone graft is performed using PRF, Regenoss (Allograft) and autogenous bone which collected during drilling. And resorbable collagen membrane was placed over the graft.

• Healing abutments were connected to the fixtures.

4️⃣ Post-Op

• Clinical and radiographic examination after surgery.

5️⃣ Final Restoration

• The final prosthetic restoration was delivered 8 months after surgery.

6️⃣ Follow-Up

[1-Year Follow-Up]

[3-Year Follow-Up]

[7-Year Follow-Up]

• The 7-year follow-up periapical radiograph shows no significant bone loss, indicating long-term success and a favorable prognosis.

7️⃣ Clinical Video