Catarina G. Rodrigues, DDS, MSc – Manuel D. Marques, DDS
A 74-year-old woman presented to a private practice with the chief complaint being that she did not want to use dentures anymore and have more comfort and better appearance. The clinical and radiographic examination revealed the absence of all teeth except the two upper canines (Fig 1-4).
Following a proper diagnosis, different treatment options were considered to restore function and aesthetics in this patient. Finally, the option chosen consisted of extracting the maxillary canines, placement of 6 implants on the upper and 5 on the lower, and immediate provisionalization of both arches with a screw-retained acrylic prosthesis.
To perform proper planning of the case, several records of the patient were obtained: Intra and extra-oral photographs, full arch IOS impressions and CBCT. A 2D facially driven digital smile design was made to aid in the planning of the position and dimension of the teeth for the future interim prosthesis (Fig.5).
The next step was pre-surgery prosthetic planning. In this case, because the patient was almost edentulous, wax rims were used to record important references such as vertical dimension, occlusal plane, and lip support (Fig. 6-7).
Using the previously made 2D smile design and the references recorded on the wax rims, a try-in of the future interim prosthesis was created (Fig. 8-9).
The approved teeth try-in was then scanned and superimposed with the preoperative intra- oral scan and CBCT to plan the implant surgery in a specific software (Fig.10,11).
Once the future implant positions were defined, they were translated into the design of the surgical template (Fig.12,13). In this case, a fully guided surgery was planned for the upper, while in the lower the surgery was performed free-hand. The multi-unit abutments for the upper jaw were also planned in the same software as the implants.
At the time of implant surgery, the stability and adaptation of the guide were checked, followed by guided preparation of the implant sites according to a specific drilling protocol and using C-tech guided surgery kit.
Three fixation pins were placed to increase the stability and precision of the guide (Fig. 14-21; 25-26).
Multi-unit abutments were seated on the 6 upper and 5 lower implants and immediately loaded with screw-retained prosthesis (22-24; 26-29).
The 2-week follow-up appointment revealed very good healing and also adequate function and aesthetics of the interim prosthesis (Fig. 30-33). 
