CATEGORY 78 AUSTRALASIAN DENTIST CLINICAL Patient Medical History: Patient: without any systemic alterations, partially edentulous in the maxilla and mandible. The patient was using a removable partial upper denture and sought dental care to seek a treatment that could provide her comfort and life quality. Planning: Planning was done using panoramic radiography, computed tomography, upper and lower arches alginate impressions, intra and extra-oral photographs and waxing. Description of the procedure: Bimaxillary surgery with the NeoArch® concept. Medication was started only on the day of surgery. After administration of local anesthetic, a total flap was performed with discharges in the region of the second molars. Bone regularization was then performed in the maxilla and mandible with gouge tweezers together with a tungsten drill. The drill sequence in the maxilla with type III bone was initial drill Ø 2.35, 3.75 (long), 3.5mm for Helix GM® Long 4.0 x 22.5mm and 4.0 x 20mm angled. For the anterior region the sequence was initial drill Ø 2.0 and 3.5mm in order to place 4.0 x 11.5mm Helix GM® implants. In the mandible with type III bone, an initial drill Ø 2.0 and 3.5mm was used for the Helix GM® 4.0 implant x 13mm and 4.0 x 16mm for the posterior implants and the same sequence for the 3.5 x 13mm implants in the anterior region. In the region posterior to the angled implants the sequence were initial drill Ø 2.0 and 3.5mm to place 4.0 x 8mm Helix GM® implants. All implants had reached a torque of 60 N.cm or more. The anterior implants were placed 2mm subcrestal, the angulated 1mm subcrestal on the mesial and the posterior to the angulated, at crestal level. 4-0 monofilament suture was used to close the flaps. The implants was immediately loaded with provisional acrylic prostheses, reinforced with preformed bars made of cobalt-chromium in the upper arch and stainless steel in the lower arch. Prosthetic description: A provisional acrylic immediate prosthesis was installed over abutments in the same day of the surgery. GM Exact Mini Conical Abutments of 4.5 mm in height and 4.8 mm in diameter were used in the anterior implants, installed with 30 N.cm; angled GM Mini Conical Abutments with 3.5mm in height in the angled implants, installed with 20 N.cm of torque; and in the implants placed posteriorly to the angled implants in the mandible, GM Mini Conical Abutments with a height of 2.5mm. Neodent® Materials: phenomenal prosthetic stability, coming from the best conical connection I know. What were the other treatment options? Why choose this solution? Considering the patient was young, we could have chosen to make a PF1 prosthesis in the maxilla, which would have involved several grafts of gum and bone, making it much more complex at the surgical level and not so favorable aesthetic results. Single implants in the edentulous regions in the mandible and crowns on teeth that were in better conditions. After talking to the patient about the possibilities, the patient decided on the NeoArch® solution, as it would bring fixed teeth in one day without grafts and maximum aesthetic results in a short period of time. What were the challenges during the treatment and how were they solved? The fact that we had to treat the patient’s gummy smile, which was resolved with a correct bone reduction. The low bone density was solved with subinstrumentation of the implants and the bicorticalization of all of them was achieved by using the Helix GM® Long in the posterior region. Tips In cases with gummy smile, a correct bone reduction is crucial, so that the transition of the prosthesis is not visible when the patient smiles. The use of long implants allowed us to reduce the cantilever and made possible the anchorage of the implants to the cortical bone of the nostril in the canine eminence area. In bone with low density, it is possible to subinstrument and fix the apex of the implant in the cortical bone of the nostril to achieve good primary stability. Full upper and lower arches rehabilitation using Helix GM® Long and NeoArch® concept By Dr Pedro Rodrigues, Portugal Dr Pedro Rodrigues 2 Helix GM® Long 4.0 x 20mm 4 GM Exact Mini Conical Abutment Helix GM® 4 – 4.0 x 13mm 2 – 3.5 x 13mm 2 – 4.0 x 8mm 6 GM Mini Conical Abutment Professional opinion about the product and procedure, focusing on your learning with the case: To this type of solution, it is important to own and work with quality brands. In this case with low bone density, implant design, the drills together with sub-instrumentation played an important role in achieving high primary stability. To optimize this stability, it is important to use cutting implants and stabilize in the cortical bone of the nostril and a compacting body to optimize the quality of the bone along the implant. We find these characteristics in the Helix GM® and Helix GM® Long, combined with a About the author u Graduation in dentistry; u Master in oral rehabilitation; u Since 2010, teaching in international courses, with live surgery and training in implant dentistry.
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