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Dr. Dominic Hützen 4+ clinical case fig 10
Neoss4+™ clinical case

Immediate implant placement in the maxilla and full-arch rehabilitation

Dr. Dr. Dominic Hützen, MD, DDS
Implantologist
Mülheim an der Ruhr, Germany

Case facts

Patient:

A 78-year-old female patient in generally good health.

Clinical problem:

The patient presents with a failing tooth-supported telescopic bridge in the maxilla. The remaining maxillary teeth cannot be saved and require extraction.

Clinical solution: 

The extraction of three maxillary teeth, followed by the immediate placement of four implants. Two of the posterior implants are placed at an angle for optimal support. Multi-Unit Abutments are installed immediately after implant placement. A provisional screw-retained bridge is placed on the same day as the surgery, with the final prosthesis scheduled for future placement.

Treatment plan:

- Extraction of three maxillary teeth.
- Immediate placement of four implants.
- Installation of four Multi-Unit Abutments.
- Use of four Multi-Unit Impression Coping Closed Tray.
- Application of four Multi-Unit Healing Caps.
- Installation of provisional screw-retained bridge.

Products:

4 Neoss ProActive Edge implants
4 Multi-Unit Abutment 30° 3.0 mm
4 Multi-Unit Impression Coping Closed Tray 6 mm
4 Multi-Unit Healing Cap

Conclusion: 

The Neoss4+ treatment solution for the upper jaw involves the placement of four implants with Multi-Unit Abutments. A provisional screw-retained prosthesis is fitted on the same day as the surgery, with plans for the final prosthesis to be placed at a later date.

Step by step

Step by step

  • Dr. Dominic Hützen 4+ clinical case fig 1
    Figure 1.

    Initial clinical situation with existing telescopic bridge in place in the upper jaw.

  • Dr. Dominic Hützen 4+ clinical case fig 2
    Figure 2.

    Initial clinical situation after removal of failing telescopic bridge.

  • Dr. Dominic Hützen 4+ clinical case fig 3 replaced
    Figure 3.

    Extraction of failing teeth in anterior maxilla.

  • Dr. Dominic Hützen 4+ clinical case fig 4
    Figure 4.

    Occlusal view after extraction. A full thickness flap was raised from molar area to molar area and the bone crest was levelled.

  • Dr. Dominic Hützen 4+ clinical case fig 5
    Figure 5.

    Four Neoss ProActive Edge implants were immediately installed. The anterior implants were 4.0 x 15 mm.

  • Dr. Dominic Hützen 4+ clinical case fig 6
    Figure 6.

    The two posterior implants (4.5 x 15 mm) were tilted to maximize the distance between the implants, to avoid the sinus, to maximize the contact with available bone, and to increase stability.

  • Dr. Dominic Hützen 4+ clinical case fig 7
    Figure 7.

    Occlusal view of the placed implants

  • Dr. Dominic Hützen 4+ clinical case fig 8
    Figure 8.

    Neoss Multi-Unit Abutment 30° 3.0 mm. The angulated abutments are delivered with a plastic holder to facilitate installation.

  • Dr. Dominic Hützen 4+ clinical case fig 9
    Figure 9.

    Placement of four Neoss Multi-Unit Abutments 30° 3.0 mm. The abutments were torqued to 32 Ncm.

  • Dr. Dominic Hützen 4+ clinical case fig 10
    Figure 10.

    The angulated Neoss Multi-Unit Abutments re-aligned the prosthesis interfaces to achieve a passive fit of the prosthesis.

  • Dr. Dominic Hützen 4+ clinical case fig 11
    Figure 11.

    Neoss Multi-Unit Impression Copings Closed Tray were placed on abutment level.

  • Dr. Dominic Hützen 4+ clinical case fig 12
    Figure 12.

    Soft tissue sutured around impression copings for impression taking using closed impression technique.

  • Dr. Dominic Hützen 4+ clinical case fig 13
    Figure 13.

    Neoss Multi-Unit Healing Caps were placed on the Multi-Unit abutments.

  • Dr. Dominic Hützen 4+ clinical case fig 14
    Figure 14.

    CBCT image showing implant positions and re-angulation with Multi-Unit Abutments to achieve parallel prosthetic platforms.

  • Dr. Dominic Hützen 4+ clinical case fig 15
    Figure 15.

    Sheffield testing on model to check passive fit of the provisional framework on implants.

  • Dr. Dominic Hützen 4+ clinical case fig 16
    Figure 16.

    A metal framework covered with composite was manufactured in the lab. Try-in of screw retained provisional restoration on model.

  • Dr. Dominic Hützen 4+ clinical case fig 17
    Figure 17.

    The provisional restoration was delivered the day after surgery. Facial view.

  • Dr. Dominic Hützen 4+ clinical case fig 18
    Figure 18.

    Provisional restoration, occlusal view.

  • Dr. Dominic Hützen 4+ clinical case fig 19
    Figure 19.

    Facial view of patient when removing stitches 7 days after surgery.

“Multi-Unit Abutments expand possibilities once more while the fundamental core idea of the system remains unchanged - simplicity together with dental solutions at the highest level.”
Dr. Dr. Dominic Hützen, MD, DDS, Implantologist Germany

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