This case demonstrates both the surgical and prosthetic treatments, which provided a seventy-five-year-old professional male patient (who travels frequently) with the comfort of having a fixed maxillary prosthesis throughout his three years of treatment. Initially, a single molar implant was placed with an internal sinus lift procedure, which after its integration provided stability for a fixed transitional prosthesis. Immediately following the extraction of two right premolar teeth and a left molar and their replacement with implants, a transitional prosthesis was inserted.
After the integration of the three additional implants, his remaining teeth were removed, and a second transitional TRINIA® prosthesis was inserted onto four Fixed-Detachable Universal Abutments (FDUAs), which provided aesthetics and comfortable functioning during the healing of a significant anterior bone grafting procedure utilizing SynthoGraft® with a titanium mesh membrane and osseointegration of two additional implants. Subsequent to the osseointegration of the newly placed implants and the removal of the failed left posterior implant, a digital abutment-level scan or impression was made for the fabrication of a permanent screw-retained TRINIA® prosthesis on five implants with FDUAs and Copings. A sixth implant abutment, which was too facially positioned is being initially used as a rest and will be replaced with an angled FDUA and retrofitted chairside with a Coping to a more palatal position after further maturation of the significant anterior bone graft.
An occlusal registration was made using conventional material between the mandibular teeth and the palate and alveolar ridge areas of the maxilla. Unfortunately, since the digital abutment-level full-arch intraoral scan was apparently not precisely accurate, an abutment-level conventional open tray impression was made. The screw-retained Impression Copings were joined with an injectable resin material to assure their relative positioning within the impression material. Using the new stone model, the FDUA Copings were repositioned in the TRINIA® prosthesis, which was subsequently successfully seated intraorally. Once the final TRINIA® prosthesis with five FDUA Copings was passively seated on the six implants, it was fastened in place with different standard lengths of retention screws, whose lengths were shortened so that they were slightly below the occlusal surface of the prosthesis. The spaces between the Vaseline-coated retention screws and the TRINIA bores were filled with an injectable resin, which facilitated the removal of the prosthesis for the removal of any extraneous resin cement prior to being refastened with retention screws, which were aesthetically covered with a composite resin.
