Dentist: Dr Gerry Skeffington
Treatment: Dual arch rehabilitation
Patient: 57-year-old female with limited bone volume requiring dual arch rehabilitation
Background
A 57-year-old female patient presented for dual arch rehabilitation.
Limited bone volume made the case particularly challenging from both a planning and surgical perspective, with careful consideration required to maintain the intended implant and restorative positions across both arches.
Assessment
Initial assessment confirmed that the available bone would require careful consideration when planning implant placement, particularly within the upper left quadrant.
The case was initially planned as a dual arch rehabilitation, with implant positions determined in relation to the intended restorative outcome.
Planning
The case was planned from a prosthetically driven perspective, with the intended implant positions established in relation to the final restorative outcome across both arches.
Given the limited bone volume, the planning also allowed for the possibility that not all implants could be placed at the initial surgical stage. Particular attention was given to the upper left quadrant, where the available bone was insufficient to safely accommodate the planned implant position.
Rather than compromise the prosthetically driven position or alter the restorative plan, the decision was made to proceed with sinus grafting and adopt a staged approach. The grafted site was then allowed to heal before returning to place the remaining implant using a dedicated Patterson guide, ensuring that the original planned position could be reproduced accurately once adequate bone volume had been established.
Initial Surgery
During the first surgical stage, it was not possible to place all of the implants due to insufficient bone volume in the upper left quadrant.
Rather than compromise the planned implant position, the decision was made to carry out sinus grafting in this area before returning to complete implant placement.
This allowed the intended restorative pathway to be maintained while creating the bone volume required for the remaining implant.
Second-Stage Implant Placement
Approximately six months following the sinus graft, the patient returned for the second stage of implant surgery.
A Patterson guide was designed for this stage of treatment to support accurate placement of the remaining implant within the grafted area.
The guide performed extremely well clinically, making implant placement straightforward and predictable. Postoperative radiography confirmed that the implant had been positioned directly within the centre of the grafted area, in accordance with the planned position.
Provisional Restorations
Following implant integration, Quoris3D provided provisional restorations to support the transition towards the definitive prostheses.
This provisional phase was used to assess and refine the aesthetics, occlusion and overall restorative position in the mouth before final manufacture. It also provided a valuable clinical reference, allowing any required adjustments to be incorporated into the definitive design.
By using the provisional restorations as part of the restorative workflow, the final prostheses could be developed from a clinically tested and approved position.
Final Restoration
Once the provisional phase had established the required aesthetic and functional outcome, the case could progress to the definitive restorative stage.
The staged surgical and restorative approach allowed the treatment to be adapted to the anatomical limitations identified during surgery while maintaining control of the planned implant and prosthetic positions.
Outcome
This case demonstrates the importance of detailed planning and flexibility when managing a complex dual arch rehabilitation with limited available bone.
By incorporating sinus grafting, staged implant placement and a carefully managed provisional phase, the team was able to maintain the intended restorative pathway without compromising implant positioning.
The postoperative radiograph confirmed accurate implant placement within the grafted site, while the provisional stage provided the opportunity to refine aesthetics, occlusion and restorative position before the definitive restorations were completed.
