In recent years the post-extraction implant prosthesis with immediate loading has become more and more the primary choice for the prosthetic restoration of complex cases also in the atrophic upper maxillary using the premaxillary bone with long implants and angled components that allow the avoidance of more complex surgical strategies (sinus lift), therefore remaining in the sphere of less invasive surgery. Thanks to dental scientific research, implant manufacturers have put more and more evolved implant components on the market which offer the possibility of making immediate temporary prostheses in a shorter space of time. The ever increasing demand for aesthetic appearance associated with function leads us to use materials of the latest generation such as zirconium oxide, which is being used more and more as an alternative material for the construction of biocompatible prostheses that remain stable over time and have a high aesthetic value. A circular screwed prosthesis was made with a pink aesthetic finish in monolithic zirconia and ceramic. The clinical case examined concerns a male patient aged 62 affected by chronic evolving periodontitis with multiple edentulism, a smoker, with recurrent episodes of acute abscess inflammation, who asked for the rehabilitation of the upper arch, with functional and aesthetic restoration (photo 1). On the upper arch the patient wore a fixed temporary post in acrylic alloy, cemented onto the remaining teeth that were mostly irremediably compromised, with widespread multiple bone defects. The OPT X-ray examination (photo 2) showed that there was still a good quantity of bone in the premaxilla, so we were able to chose a post-extraction implant solution with immediate loading using long implants (18 mm) angled at 30 degrees at the two ends. The 3D examination clearly showed the presence of adequate bone volumes despite the presence of widespread bone defects linked to periodontitis. The operation was conducted with an intrasulcular incision from sixteen to twenty-six with detachment of two flaps with total thickness (photo 3); the extractions were performed followed by cleaning of the alveolar cavities and of their cystic inflammatory contents with remodelling of the alveolar crests (photo 4). Six fixtures were inserted, two of which with an angle of 30 degrees at the ends, taking care to under-prepare the site so as to be able to use high inserting torques; the P.A.D. and the transfers were positioned and the intra-operative impression was taken in plaster for the construction of the screwed prosthesis with immediate loading.
