The Award contest 2017/ 27 February 2017/

Case 105 | The Award 2017 | Philippines

Dr. Ricky Martin Llorca

the case: female, 49 years old. complaining of loose denture and difficulty in mastication & speaking.

clinically: upper jaw-kennedy class 3 modification 2. lower jaw kennedy class 1 modification 1. old denture esthetically acceptable but poor in retention & function

radiographically: upper anteriors with deficient residual ridge, posteriorly with extreme development of sinus with marked thinning ofthe alveolar process and the roots of the remaining tooth projects into the sinus. lower deficient residual ridge all over the edentulous area but with thick body of the mandible and enough height & clearance from the mandibular canal.

recommendation: upper jaw needs bone augmentation, a block graft for the anterior and bilaterral sinus lifting and grafting. since the patient is reluctant of invasive procedure.

instead we proposed a combination of fixed and removable denture to improved the functions and retention. lower jaw also needs bone augmentations if conventional implant and crown are to be planned but instead we proposed a lesser invasive and faster treatment which is the “all on four treatment concept”

treatment plan: 1st lower – cbct diagnosis, implant planning, restorations planning.

2nd lower – surgical guide fabrication, local anesthesia, implant placement surgery old denture relining.

3rd lower- 6 weeks healing, provisional fixed denture (Hybrid)

4th lower- pick up impression of implants, crown & bridge of the 4th quadrant try-in & installation of the final hybrid denture.

5th upper- crown & bridge preparations, Bridge try-in with precision attachment, bridge pick up impression, bridge and RPD try-in, bridge cementation and RPD installation.

results: Denture esthetic on both upper and lower is achieved, stability and retention is remarkable.

most importantly the patient is satisfied in all aspects of the denture function.