Initial situation

A 52-year-old healthy male patient with an unremarkable medical history presented to our clinic. The clinical examination showed a reduced number of teeth in both jaws, periodontal disease and hopeless dentition with a cyst and bone defect in #25 and pneumatized maxillary sinuses (Figs 1,2). All teeth presented mobility. A reduction of the occlusal vertical dimension caused by the loss of teeth, with impaired masticatory function and unsatisfactory aesthetic appearance was also observed (Fig 3).

The patient reported a decreased quality of life due to these facts.

Treatment planning

Considering the patient remaining terminal dentition, and after a careful clinical and radiographic assessment; a full arch rehabilitation with 4 implants in the maxilla using Straumann® BLX Implants with the Pro Arch concept was planned. The posterior implants were tilted due to limited bone availability in the maxilla caused the pneumatized maxillary sinuses. Furthermore, an immediate implant placement and provisionalization was chosen in order to deliver immediacy concept and aesthetic appearance the same day of surgery with a provisional acrylic-metal-reinforced prosthesis.

Surgical & Prosthetic procedures

A mucoperiosteal flap was elevated to expose the palatal and buccal bone, and the extraction of tooth #25 with resection of the cyst in the same location was performed (Fig 4-6).

Alveoplasty of the maxilla and exposure of the nasal cavity was performed with a sub-nasal lift procedure to have a bicortical anchorage of the anterior axial implants protecting the nasal membrane (Fig 7-9). Implant osteotomies were performed with tilting orientation 30º for posterior implants in position #16 & #25, avoiding the pneumatized maxillary sinuses; and two axial implant osteotomies in position #12 & #22, to achieve an implant apical anchorage in the nasal floor (Fig 10-13). We selected 2 Straumann® BLX 3,75x18mm Roxolid® SLActive® for posterior tilted implants and 2 Straumann® BLX 3,75x12mm Roxolid® SLActive® for anterior axial implants (Fig 14,15). The insertion of the Straumann BLX implants were perform obtaining optimal torque values of at least 35 Ncm for all implants, being able to perform a predictable immediate loading of the prosthesis (Fig 16-20).

We placed two straights Screw-retained Abutments diameter 4.6mm, GH 3.5mm for the anterior implants and two Screw-Retained Abutments 30º diameter 4.6mm, GH 4.5mm for the posterior tilted implants (Fig 21-22). Moreover, we performed a guided bone regeneration procedure with Straumann® Xenograft and a Straumann® Membrane Flex™ in the containing bone defect located on the mesial area of implant position #25 (Fig 23). Flap was closed with free-tension sutures.

A panoramic radiograph post-op was taken before continuing with the prosthetic steps for the manufacturing of the immediate loading prosthesis (Fig 24,25).

Following the loading of the provisional prosthesis, a Cone beam computed tomography (CBCT) was taken and a correct stabilization and fit of the prosthesis was assured. Clinical front-lateral pictures were also registered.

Treatment outcomes

An outstanding function and aesthetic result the same day of surgery was obtained using the immediacy Straumann Pro Arch concept®. The Panoramic radiograph and CBCT tomography showed an optimal distribution of the number implants in the maxilla (Fig 26-29).

The patient was very happy to receive an immediate fixed restoration that allowed him to recover the function and esthetics that he was lacking, and more importantly his quality of life. He also received oral hygiene instructions and was involved in a maintenance program with regular check-ups.

Testimonial by Dr. Vladimir García Lozada

“Straumann® BLX implant design it is a great development that can transform a difficult case into an easy one. The hydrophilicity properties of the SLActive® surface helped us to enhance the healing process. The versatility of the BLX® prosthetic components are an excellent advantage, one connection for all implants.

A reduced body of implant with large treads allowed us to perform a minimal osteotomy while obtaining an optimal primary stability with great torque values; and the platform switching, a decrease bone resorption in the crestal margin bone.

I recently performed a great series of Pro Arch concept® cases with BLX implants. The overall outcomes were very satisfactory, even in complex cases with atrophic jaws and poor bone quality”