Definitive CAD/CAM-guided prosthesis for immediate loading of bone-grafted maxilla: a case report

The reconstruction of a functional occlusion in the presence of severe residual ridge resorption remains a significant challenge for maxillofacial surgeons and prosthodontists. Removable appliances are unsuccessful in severely resorbed cases and the advanced degree of bone loss precludes conventional implant-retained prostehesis. In recent years, bone graft reconstruction of the maxilla and the mandible has been advocated to reverse the debilitating effects of alveolar ridge resorption.

The surgical objective was the reconstruction of the osseous platform of the jaws, thereby allowing implant-retained definitive prosthetic rehabilitation utilizing the Teeth-in-an-Hour concept within 4 months.

A completely edentulous patient received bone grafts from the posterior iliac crest to augment both the maxillary and mandibular alveolar ridges. The manmandible was augmented using Marx's "soft issue matrix expansion procedure" and was restored in the conventional manor using an impression and a milled framework. The maxilla underwent "inlay/onlay" bone graft augmentation of the right and left maxilla at the same time as the mandiblular procedure. Implant placement was at 4 months post-bone graft reconstruction. Immediate loading of implants into a bone graft using Nobel Biocare's Teeth-in-an-Hour protocol prelaunch was implemented. This included CT-based implant planning, simultaneous CAD/CAM fabrication of a surgical guide, a CNC-milled framework, flapless surgical placement of the implants, and immediate placement of a pre-fabricated definitive prosthesis. This approach reduced the time necessary for an edentulous patient to transform from severely atrophic alveolar support to implant-retained maxillary and mandibular prosthetic restorations. Immediate loading with an implant retained definitive prosthesis using a bone graft-reconstructed osseous platform was also performed.

The Teeth-in-an-Hour concept was utilized to restore bone grafted augmentation of the maxilla with immediate loading of a definitive prosthesis within 4 months. The remarkable accuracy of the software, minimally invasive and short surgery and treatment time, uneventful quick recovery with minimal discomfort is a benefit not only to the patient, also to the treating team.