Clinical Case No. 10: Tilted Implants, Iuxtameatal Implants, Immediate Loading

Extremely atrophic maxillary rehabilitation: Immediate loading implantology via bone-supported surgical template. The patient, a 55-year-old woman, asked for a fixed prosthesis to substitute a removable prosthesis of the upper arch. She was edentulous for a long period and seemed she could not find a solution due to the extreme atrophic condition of the maxillary basal bone. Thanks to an accurate study of CBCT exams we found a residual amount of bone in tuberal areas and around the canine tuberosity. The virtual implant position has been performed with a dedicated software in which we included the digital prosthetic mock-up. The positive outcome of digital surgery planning suggested us to build a surgical template to place the fixture in the exact position we planned. The bone-supported template is important for the surgeon to manage the thin residual bone and avoid implant misfitting. Surgical template is built with CAD/CAM technology and offers the surgeon the perfect axis and point of entry for drills. This way we can replicate the implant position as shown by the digital project. After osseointegration we reconstructed pink and white aesthetics with a screw-retained Toronto Bridge with zirconia-ceramic prosthesis cemented on a titanium bar.