Using the "One Shot" Concept for Immediate Loading Implant Protocol in Edentulous Patient Rehabilitation with a Fixed Prosthesis: A 6-Year Follow-Up

Abstract

Immediate-loaded implants with a fixed prosthesis are a viable option for the restoration of edentulous ridges. Several procedures now allow for the fabrication of immediate-loading provisional and definitive prostheses. However, this complex treatment is not accessible to all patients with budget restrictions. By using a unique master model with a single titanium framework prosthesis can simplify and shorten the treatment, as well as reduce costs. After surgical placement of implant fixtures, an interim prosthesis was fabricated using a laser-welded definitive titanium framework. The prosthesis was fitted intraorally following the immediate loading protocols. The master cast model used to fabricate interim prosthesis was conserved and subsequently used in modifying the final prosthesis. After the healing process and complete soft tissue stability, an impression was made to register the clearance between the gingiva and resin. The light silicone material was directly injected under the prosthesis screwed in the mouth. In the master cast model, the stone was eliminated between the implants and a new plaster was poured to modify the crest profile with the posthealing new shape. With this modified model, it is possible to rehabilitate the denture to the new gingival anatomy in 3 to 4 hours and, if necessary, the tooth rearrangement. This "one shot" concept combines the single definitive titanium welded framework and limited laboratory work with a unique master model thereby decreasing the cost and the time of treatment.

Figure 1

Impression transfer copings immediately after surgery.

Figure 2

Definitive titanium implant framework fabricated using a laser-welding technique. (a) Segments of titanium rod adapted and inserted into the space between the titanium milled cylinders. (b) Definitive framework. (c) Pink opaquer layer was applied to increase prosthetic resistance under occlusal forces. (d) Interim prosthesis with acrylic teeth after finishing. Occlusion was shortened to the second premolar.

Figure 3

Interim prosthesis immediately after installation.

Figure 4

Preparation after osseointegration and gingival recession. (a) After healing, clearance between the alveolar crest and the denture. (b) Stone was eliminated between the implant abutment analogs on the master cast model.

Figure 5

Posthealing prosthetic transformation. (a) Silicone impression material was injected under the prosthesis to fill the space, and occlusion was registered. (b) After the preparation of the model, the complex prosthesis and silicone are screwed onto the master cast model. (c) The restoration was boxed in the lingual area on the modified cast model.

Figure 6

Master cast model modification. (a, b) New dental stone is poured into the space conserved on the buccal side. (c) Master cast model with the new crest anatomy.

Figure 7

Final prosthesis. The molars and cantilevers were in occlusion, and a new adaptation to the crest was performed. The peri-implant tissues appeared healthy, indicating good oral hygiene level maintenance.

Figure 8

Radiographic panoramic control. After 6 years, bone level was stable.