Hybrid maxillary and mandibular prostheses All and Four technique, Case Report

Background: Retained implant prostheses and supported implants provide absolute comfort, but the waiting time for rehabilitation sometimes frustrates patients. Immediate loading is possible if the systemic, skeletal and joint requirements are met. A modified Branemark protocol is proposed for the implantation of hybrid prostheses and immediate loading was permitted for all 4 superior and inferior (upper and lower) hybrid prostheses. Case Report: In an 81-year-old patient with systemically compromised hypothyroidism and controlled hypertensive heart disease (itulsan 40 mg/levothyroxine 50 µg), surgery with sedation was planned for the placement of 8 postextraction hybrid implants (SIN 3.75x11.5, Brazil, 4 upper and 4 lower). The surgery was planned according to nonrestrictive guidelines, and bone densitometry (type 3 and 4) was performed by zone taking into account safety margins and limits with anatomical structures according to computed tomography. Conventional milling was commenced with a torque of 45 Newton, prosthetic attachments were splinted with orthodontic wire 11 and thermocuring acrylic, and impressions were takenusing conventional methods (President elastomers - Coltene - USA). A wax test of the prosthesis was performed to control the facial profile, vertical dimension and occlusion. Vacuum muffling was performed for 2 hours, and the prosthesis was polished and placed immediately before occlusal adjustment. Provisional torque of 15 Newtons was applied, and the chimneys were protected with A3 resin. Conclusions: The immediate loading protocol for the placement of hybrid prostheses was successful, and planning facilitated clinical and laboratory work.

Keywords: Surgery oral, dental implants, dental prosthesis implants-supported, Cone Beam Computed Tomography