The case presented involved total rehabilitation in a patient aged 58 years, a smoker with serious endodontic-periodontal impairment in both arches, in a situation of serious deep bite not resolved by previous prostheses.
Surgical procedures were performed in two sessions.
During the first session the impaired teeth were removed from the upper arch and implants were inserted immediately, at the same time performing regeneration with synthetic bone particulate and resorbable membranes, adding PRGF where necessary. All implants were inserted at immediate post-extraction sites, except for the implant inserted at position 14.
During the same session, immediate loading was carried out with the disparallel screw-retained prosthesis technique (DSP), followed by the intraoral welding of a titanium bar onto the temporary sleeves using argon syncrystallization. The temporary prosthesis, to remain in place for 6 months, made it possible to achieve raised mastication for an initial correction of the deep bite.
In the second session, an implant was inserted at position 37 in the lower arch and 4 implants were inserted in the rear portion of the lower right-hand quadrant, where a split-crest procedure was carried out with the simultaneous insertion of implants with a small diameter.
At the same time temporary prostheses were fitted to the teeth of the frontal group.
After six months re-entry was performed on both the upper and lower arches, and impressions were made for the production of the final prostheses.
On the upper arch, between the canines the DSPs were removed and personalized posts were inserted suitable for the support of single crowns in lithium disilicate (cemented technique). The DSPs in rear areas were maintained, and a screw-retained metal-ceramic prosthesis was fitted.
In the lower arch, the teeth were prosthesized with a zirconium-ceramic structure, and in the rear areas, on the right a screw-retained ceramized chrome-cobalt structure was fitted, completed by two lithium disilicate crowns on the left. Cementation was carried out for both disilicate and zirconium with composite materials.
