Implant-prosthetic rehabilitation of both arches with the use of Toronto Bridge on tilted implants at immediate load

Becatelli A., Biscaro L., Soattin M., Ferlin P.

Becatelli A.

Graduated in Medicine and surgery. In the two-year period 1985-86, he attended courses in the treatment of total edentulism with osseointegration taught by Professor I. Branemark and courses with the same implant systematics taught by Professor Van. Steemberghe.
In 1997, he attended the course in implant surgery with osteotomy techniques taught by Professor Summers.
In 1998, he attended the implant surgery course taught by Doctors G. Bruschi and Scipioni
In 2000, he attended the surgical anatomy course taught by Professor G. Godlewski at the University of Montpellier
In 2007, he completed a “clinical residency” at the clinic of Doctor Malò.
Co-author with Dr L. Biscaro and Dr P. Poggio of the chapter on “La Riabilitazione Complessa del Paziente Totalmente Edentulo” in the “Il Carico Immediato” book by T. Testori, F. Galli, and M. Del Fabbro. Author of various publications in international journals and speaker at national congresses.
He specialises exclusively in implant surgery at his clinic of Villa Bartolomea (VR) and for many years has been collaborating with Dr L. Biscaro in the management of complex rehabilitation surgeries.

Biscaro L.

DDS in Bologna University, active member of AIOP and SIO. Past-President of AIOP. Private practice in Adria (RO), with special dedication to complex rehabilitations

Soattin M.

Dental technician since 1986, owner of the “4M di Soattin Massimo” laboratory which is specialized in fixed prostheses on teeth and both metal-ceramic and zirconia-ceramic implants. Active Member of ANTLO and AIOP. Winner of the 2000 “ROBERTO POLCAN” AIOP-A.N.T.L.O. award.

Ferlin P.

Graduated with honors in Dentistry at the University of Ferrara. Cooperates with dr. A. Becattelli.

NumeriUno, 10: 10-12, 2011
This case report illustrates the treatment of a patient with total edentulism with the insertion of only four implants for each arch. The single model technique designed by Dr L. Biscaro allowed effortless immediate prosthetisation. The case in question did not allow positioning implants with sufficient primary stability in the posterior zones. After a careful aesthetic and functional analysis, it was decided to insert the implants in the remaining bone of the pre-maxilla and the intra-foraminal zone without the use of regenerative techniques. The upper distal implants were tilted to follow the course of the front wall of the maxillary sinus. This allowed positioning the head of the implant at the level of the second premolar, thus reducing the prosthetic cantilever. Similarly, in the lower jaw, the two distal implants tilted at 45° made use of all the available bone volume without affecting the ansa of the lower alveolar nerve.
The PAD system with preformed straight abutments angled at 30° and straight abutments screwed on the head of the implants allows, in these cases, much easier insertion of the prosthesis.
The implant position is not passed on to the technician using a traditional impression, but using transfer plaques and splints. This expedient allows to position the analogs on the same model on which was executed the diagnostic wax-up and to quickly obtain provisionals with satisfying aesthetic and functional integration. The case was finalised in six months with one surgical procedure, a limited number of sessions and during the entire treatment, the patient never wore a mobile prosthesis.
The immediate load procedure combined with a correct prosthetic procedure allows ergonomically managing the case and satisfying both the objectives of the orthodontist and patient.

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