Chapter 18

Chapter 18
– Examples of Intermediate and Advanced

Cases
Implantology has revolutionized dental diagnosis and treatment planning. One purpose of this
book is to bring the entire profession into active participation in the field. Hence, the mainstream
applications of professionally accepted implant modalities have been taught in step-by-step
teaching cases. These mainstream cases are the most predictable, most standardized, and
simplest of the cases encountered in implant dentistry. They are the way to begin.
This chapter focuses on the state of the art. It highlights great accomplishments that can be
performed in implant dentistry today. The cases illustrated in this chapter represent the results of
an explosion of understanding that has occurred in only the past 3 decades. Note in reviewing the
cases that they use various modalities. The diagnosis and treatment planning for these cases
resulted from a combination of scientific, clinical, and patient-related considerations. One cannot
view these cases and conclude that another treatment plan would clearly have been superior.
More than one treatment plan may have been applicable for many of these intermediate and
advanced cases, yet each has succeeded as treated.
The authors are grateful that many of the world’s most prominent dental implant practitioners
contributed examples of intermediate and advanced treatment for this chapter. We acknowledge
their contributions, case by case, with our sincere appreciation.
The lessons to be learned herein are important. These intermediate and advanced cases
represent the apex of implant dentistry achievement. Being able to render such treatment is the
goal of many practitioners who begin with mainstream cases. It is also comforting to know that
there are fellow practitioners who can be resources for learning, and to whom patients whom one
cannot or may not wish to treat can be referred. One of the most important points of this chapter
is that there are very few patients in need who are beyond the scope of implant dentistry. Nearly
everyone can benefit from this discipline. Almost every condition of partial or total edentulism,
regardless of the extent of alveolar ridge resorption, can be treated by a practitioner who has
appropriate training and experience. In each of the cases presented in this chapter, the probable
conventional treatment that the patient would have undergone is given, to emphasize the
profound benefits offered by implant dentistry. Patients formerly were evaluated, and their
treatment plan formulated, based on available natural abutment support. Now, additional new
abutment support can be created where it would be optimal for restorative dentistry. This is the
revolution in diagnosis and treatment planning afforded by implant dentistry.
Implant dentistry is an art and a science. The mainstream applications of professionally accepted
modalities that are presented in the step-by-step teaching chapters by and large are not
interpretive. They are predictable, and can be approached in almost the same way every time.
This chapter highlights cases that pertain more to the art of implant dentistry. Determining the
treatment plan for these severely compromised patients is a creative, interpretive, and individual
process. Based on years of experience and knowledge of the procedures that tend to serve best
in one’s own hands, a treatment plan that goes well beyond the mainstream is formulated and
executed. Graduating from exclusively performing mainstream implant dentistry to these more
challenging cases, which require much creative problem solving, is extremely satisfying. Also,
nothing is more satisfying than truly helping those patients in the most need, who are the very
patients who require such treatment.
INTERMEDIATE AND ADVANCED CASES

CASE 1
Courtesy Jerry Soderstrom, Rapid City, South Dakota

Case as Presented
Female patient in her 50s. Edentulous maxilla. Except periodontally involved cuspids, edentulous
mandible.
Probable Conventional Dentistry Treatment Plan
Maxillary total removable denture. Mandibular total removable denture.
Implant Dentistry Treatment Plan

Implant
Ramus frame implant (Pacific Dental).
Prostheses
Maxillary total removable denture with future implant dentistry options. Mandibular semi-fixed
overdenture.
Figures
▪ Preoperative mandible. Splinted cuspids with clip-bars ( Fig. 18-1 , A).
▪ Preoperative radiograph. Note available bone bilaterally under sinuses, and resorbed pre-
maxilla. In mandible, periodontally involved cuspids, and bilateral shallow available bone
over inferior alveolar canals ( Fig. 18-1 , B).
▪ Postoperative view of healed ramus frame positioning ( Fig. 18-1 , C).
▪ Postoperative view of prostheses ( Fig. 18-1 , D).
▪ Postoperative radiograph of ramus frame RA-3 implant in position ( Fig. 18-1 , E).
Figure 18-1
Figure 18-1
CASE 2
Courtesy Edward A. Amet, Overland Park, Kansas
Case as Presented
Female patient in her 50s. Edentulous maxilla. Severe posterior mandibular resorption, adequate
anterior available bone.

Implants
In mandible, five root form implants (Nobel Biocare/ Steri-Oss).
Prostheses
Mandibular implant splinting mechanism with provision for O-ring retained overdenture. Maxillary
total removable denture.
Figures
▪ Preoperative view of edentulous mandible ( Fig. 18-2 , A).

▪ Preoperative radiograph. Note that only anterior segment has sufficient available bone for

endosseous implants ( Fig. 18-2 , B).
▪ Preoperative segmented radiography to aid in planning implant positioning ( Fig. 18-2 , C).
▪ Postoperative view of mandible with splinting mechanism and O-ring extensions in place.

Note quality of gingiva ( Fig. 18-2 , D).
▪ Prostheses in position ( Fig. 18-2 , E).
▪ Pleasing esthetic result ( Fig. 18-2 , F).
▪ Postoperative radiograph with splinting mechanism and O-ring extensions ( Fig. 18-2 , G).
Figure 18-2
Figure 18-2
CASE 3
Case as Presented
A female patient in her 60s. Maxillary arch presents with four teeth that can be retained.
Edentulous mandible reveals adequate available bone.

In maxilla, fixed prosthesis from right second premolar to left cuspid, and partial removable
denture. Or, removal of remaining maxillary teeth and total removable denture. In mandible, total
removable denture.
Implant Dentistry Plan

Implants
In maxilla, plate/blade form implant in each tuberosity, and one interdental plate/blade form
implant (Oratronics). In mandible, four plate/blade form implants (Oratronics).
Prostheses
In maxilla, complete-arch porcelain-to-metal fixed prosthesis supported by plate/blade form

implants and natural co-abutments. In mandible, complete-arch porcelain-to-metal fixed
prosthesis, cement retained.
Figures
▪ Radiograph taken after insertions in mandible and before insertions in maxilla. Note

available bone in man-dible and maxillary tuberosities ( Fig. 18-3 , A).
▪ Postoperative radiograph. Note distal bar and coping to extend restoration to tuberosity

implants. Distal tooth on each side of maxillary restoration is first molar ( Fig. 18-3 , B).
Figure 18-3
Figure 18-3
CASE 4
Courtesy Walter Knouse, Lumberville, Pennsylvania
Case as Presented
Female patient in her 70s. Posterior maxillary edentulism, with eight satisfactory anterior teeth.
Three remaining anterior mandibular teeth require removal. Resorbed mandibular alveolar ridges
posteriorly.
Maxillary partial removable denture. Mandibular total re-movable denture.

Bone Enhancement
Maxillary bilateral subantral augmentation to accommodate large size of planned plate forms.
Augmented with demineralized freeze-dried bone, tricalcium phosphate, and Lambone.
Implants
Plate form implants (Omni) in posterior maxilla. Man-dibular total subperiosteal implant.
Prostheses
Maxillary partial-arch porcelain-to-metal fixed prostheses supported by implant and tooth

abutments. Mandibular complete-arch porcelain-to-metal fixed prosthesis supported entirely by
implant.
Figures
▪ Preoperative radiograph. Remaining mandibular teeth require removal ( Fig. 18-4 , A).
▪ Postoperative radiograph with implants and prostheses in position ( Fig. 18-4 , B).
Figure 18-4
Figure 18-4
CASE 5
Courtesy Ralph Roberts, Rio Dell, California
Case as Presented
Female patient in her 60s. Edentulous maxilla, edentulous mandible, severely resorbed
posteriorly.
Maxillary and mandibular total removable dentures.

Implant
Ramus frame implant (Pacific Dental).
Prostheses
Maxillary total removable denture. Mandibular semi-fixed overdenture.
Figures
▪ Preoperative view of edentulous mandible. Note alveolar ridges positioned inferior to floor of

mouth and raised tongue ( Fig. 18-5 , A).
▪ Preoperative radiograph. Note minimal posterior available bone ( Fig 18-5 , B).
▪ Postoperative view of mandible with healed implant in position ( Fig. 18-5 , C).
▪ Postoperative view of mandibular semi-fixed overdenture. Note locking mechanism ( Fig.

18-5 , D).
▪ Postoperative radiograph showing ramus frame implant in position ( Fig. 18-5 , E).
Figure 18-5
Figure 18-5
CASE 6
Courtesy Keisuke Wada, Nagoya, Japan
Case as Presented
Male patient in his teens with congenital ectodermal dysplasia. Totally edentulous except for one
tooth. Severely resorbed ridges, xerostomia. Unable to wear lower denture.
Serial fabrication of maxillary and mandibular total removable dentures to accommodate growth
pattern. Prognosis poor.

Implants
Five screw-type root form implants (Nobel Biocare) in anterior mandible.
Prostheses
Maxillary total removable denture. In mandible, implant splinting mechanism with provision for
screw-retained fixed overdenture.
Figures
▪ Preoperative view of mandible. Note severe resorption ( Fig. 18-6 , A).
▪ Preoperative radiograph. Note severely resorbed ridges in entire maxilla and posterior

mandible ( Fig. 18-6 , B).
▪ Postoperative radiograph. Note five screw-type root forms inserted into anterior mandible (

Fig. 18-6 , C).
▪ Postoperative view of implants, splinting mechanism, and mandibular screw-retained fixed

overdenture. Maxillary total removable denture ( Fig. 18-6 , D).
Figure 18-6
Figure 18-6
CASE 7
Courtesy Katsura Omura, Kyoto, Japan

Case as Presented
Male patient in his 50s. Edentulous mandible. Maxillary teeth present from right first premolar
through left second premolar.
Maxillary partial removable denture. Mandibular total removable denture.

Implants
Five plate/blade form implants (Oratronics).
Prosthesis
Mandibular porcelain-to-metal 14-unit complete-arch fixed prosthesis.
Figures

▪ Preoperative radiograph ( Fig. 18-7 , B).
▪ Postoperative view of completed prosthesis inserted ( Fig. 18-7 , C).
▪ Postoperative radiograph ( Fig. 18-7 , D).
Figure 18-7
Figure 18-7
CASE 8
Courtesy Eiichi Kojima, Tokyo, Japan
Case as Presented
Edentulous maxilla. Edentulous mandible.

Implant
Mandibular total subperiosteal implant.
Prostheses
Figures
▪ Preoperative view of mandible. Note band of attached gingiva ( Fig. 18-8 , A).
▪ Postoperative view of mandible. Inserted implant with well-healed pergingival sites ( Fig. 18-

8 , C).
▪ Postoperative view of completed prostheses in position ( Fig. 18-8 , D).
▪ Postoperative radiograph ( Fig. 18-8 , E).
Figure 18-8
Figure 18-8
CASE 9
Case as Presented
Female patient in her 60s. Edentulous maxilla. Edentulous mandible.

Implants
Mandibular plate/blade form implants (Oratronics), single abutment in right and left posterior,
double abutment between mental foramina.
Prostheses
Complete-arch reinforced acrylic fixed prosthesis.
Figures
▪ Preoperative radiograph ( Fig. 18-9 , A).

▪ Postoperative view of mandibular complete-arch fixed prosthesis. Note ridge lapping ( Fig.

18-9 , B).
▪ Postoperative radiograph. Note reinforcing metal rod baked within complete-arch acrylic

fixed prosthesis ( Fig. 18-9 , C).
Figure 18-9
Figure 18-9
CASE 10
Case as Presented
Female patient in her 70s. Edentulous maxilla. Edentulous mandible.


Implant
Custom-made mandibular tripodal subperiosteal, fabricated on model created with aid of

computerized axial tomography (CAT).
Prostheses
Maxillary total removable denture with future implant dentistry options. Mandibular semi-fixed
overdenture.
Figures
▪ Preoperative edentulous mandible. Note relative positions of tongue, tissues of floor of

mouth, and clinical ridge crest ( Fig. 18-10 , A).
▪ Preoperative radiograph. Severe alveolar ridge atrophy ( Fig. 18-10 , B).
▪ Postoperative view of healed tripodal subperiosteal positioning ( Fig. 18-10 , C).
▪ Postoperative view of prostheses ( Fig. 18-10 , D).
▪ Postoperative radiograph. Classic placement of mandib-ular tripodal subperiosteal implant (

Fig. 18-10 , E).
Figure 18-10
Figure 18-10
CASE 11
Courtesy Edward M. Amet, Overland Park, Kansas
Case as Presented
Female patient in her 50s. Edentulous maxilla with adequate available bone. Edentulous
mandible with severe resorption.

Implant
CAD/CAM-generated tripodal subperiosteal in mandible.
Prostheses
Maxillary total removable denture. Mandibular semi-fixed overdenture
Figures

▪ Preoperative radiograph. Note severe mandibular atrophy ( Fig. 18-11 , B).
▪ Preoperative view of laboratory wax-up of tripodal subperiosteal on computer-generated

model ( Fig. 18-11 , C).
▪ Postoperative view of healed implant in position. Note keratinized gingiva around left

posterior pergingival site ( Fig. 18-11 , D).
▪ Postoperative view of esthetics ( Fig. 18-11 , E).
▪ Postoperative radiograph of tripodal subperiosteal in position ( Fig. 18-11 , F).
Figure 18-11
Figure 18-11
CASE 12
Case as Presented
Female patient in her 60s. Edentulous maxilla. Edentu-lous mandible with adequate available
bone.

Implants
Double-abutment plate/blade form implant in anterior mandible and two ramus blades (Pacific
Dental).
Prostheses
Maxillary total removable denture. Mandibular complete-arch porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative view of edentulous mandible. Note anatomy of ridge ( Fig. 18-12 , A).
▪ Preoperative radiograph. Note adequate available bone in mandible, marginal available

bone in maxilla ( Fig. 18-12 , B).
▪ Postoperative view of mandible showing complete-arch porcelain-to-metal fixed restoration

in position ( Fig. 18-12 , C).
▪ Postoperative radiograph showing implants and final restoration in place ( Fig. 18-12 , D).
Figure 18-12
Figure 18-12
CASE 13
Case as Presented
Female patient in her 60s. Edentulous maxilla. Mandible previously treated with five screw-type
root forms and fixed prosthesis with distal cantilevering on each side, currently irreversibly
compromised.
Maxillary total removable denture. Removal of all mandibular implants, and following healing, a
total removable denture.

Implant
Mandibular tripodal subperiosteal implant.
Prostheses

Figures
▪ Preoperative view showing compromised previously placed implants and prosthesis. Note

extremely poor hygiene ( Fig. 18-13 , A).
▪ Preoperative radiographs before implant removals ( Fig. 18-13 , B).
▪ Preoperative radiograph following implant removals and healing ( Fig. 18-13 , C).
▪ Postoperative view of final prostheses in position. Note locking device on mandibular semi-

fixed denture ( Fig. 18-13 , D).
▪ Postoperative radiograph showing tripodal subperiosteal in position. Note positions of screw

retention ( Fig. 18-13 , E).
Figure 18-13
Figure 18-13
CASE 14
Courtesy Neal B. Gittleman (restoration) and R. Kent Stobaugh (insertion), Houston, Texas
Case as Presented
Female patient in her 40s. In maxilla, residual edentulous alveolar ridges were severely resorbed.
Remaining teeth were periodontally involved. Mandible presented with pseudo-prognathism, and
periodontal involvement of remaining teeth. Both arches contained ill-fitting dentures.
Removal of all remaining teeth. Fabrication of maxillary and mandibular total removable dentures.

Preliminary Procedures
Removal of all remaining teeth and alveoloplasty.
Bone Enhancement
Right maxillary subantral augmentation and pre-maxilla symphyseal onlay bone graft.
Implants
Maxilla implanted with six screw-type root form implants (Nobel Biocare/Steri-Oss). Mandible
implanted with five screw-type root form implants (Nobel Biocare/Steri-Oss).
Prostheses
Maxillary implants splinted with incorporated retention mechanism for overdenture. Mandibular
fixed screwretained overdenture.
Figures
▪ Preoperative view of patient. Note anterior occlusion and prognathism ( Fig. 18-14 , A).
▪ Preoperative lateral cephalometric radiograph. Note pseudo-prognathism ( Fig. 18-14 , C).
▪ Postoperative view of maxilla with implant splint and incorporated retention mechanism in

position ( Fig. 18-14 , D).
▪ View of maxillary overdenture—tissue surface ( Fig. 18-14 , E).
▪ Postoperative view of mandibular fixed screw-retained prosthesis ( Fig. 18-14 , F).
▪ Postoperative view of esthetic result ( Fig. 18-14 , G).
▪ Postoperative radiograph ( Fig. 18-14 , H).
Figure 18-14
CASE 15
Case as Presented
Male patient in his 50s. Edentulous maxilla. Partially edentulous mandible in right second
premolar and molar area.
Maxillary total removable denture. Mandibular partial removable denture.

Bone Enhancement
Maxillary anterior onlay bone graft and bilateral subantral augmentation.
Implants
Eleven root forms in maxilla, and two in mandible (Calcitek).
Prostheses
Maxillary 14-unit complete-arch splinted fixed prosthesis. Mandibular 3-unit splinted fixed
prosthesis.
Figures
▪ Preoperative edentulous maxilla ( Fig. 18-15 , A).

▪ Preoperative radiograph. Severe maxillary alveolar bone resorption. Abundant right

mandibular available bone ( Fig. 18-15 , B).
▪ Postoperative esthetics of maxillary fixed prosthesis ( Fig. 18-15 , C).
▪ Postoperative radiograph. Eleven well-placed and splinted root forms in maxilla. Note

anterior onlay and subantral augmentations ( Fig. 18-15 , D).
Figure 18-15
Figure 18-15
CASE 16
Case as Presented
Following removal of two anterior teeth, maxilla was totally edentulous. Mandible cuspid and first
premolar splinted on each side. Other posterior tooth roots on each side required removal.


Implants
In anterior maxilla, six root form implants (Nobel Biocare/Steri-Oss). In anterior mandible, two root
form implants (Nobel Biocare/Steri-Oss), and in posterior mandible, custom-made plate/blade
form implant on each side.
Prostheses
Two porcelain-to-metal fixed prostheses. Distal cantilever on each side of maxilla.
Figures
▪ Preoperative radiograph of mandible ( Fig. 18-16 , A).

▪ Postoperative radiograph showing variability of implant support with natural co-abutments (

Fig. 18-16 , B).
Figure 18-16
Figure 18-16
CASE 17
Case as Presented
Male patient in his 70s. Edentulous maxilla with abundant available bone everywhere. Bilateral
posterior edentulism in mandible with abundant available bone.

Implants
In maxilla, four plate/blade form implants (Oratronics). In mandible, two plate/blade forms
(Oratronics), one endodontic stabilizer for left lateral incisor (Oratronics).
Prostheses
Maxillary complete-arch porcelain-to-metal fixed prosthesis. Mandibular complete-arch porcelain-

to-metal fixed prosthesis supported by plate/blade form and natural co-abutments.
Figures
▪
Preoperative radiograph. Note abundant available bone in both arches ( Fig. 18-17 , A).
▪
Preoperative view of edentulous maxilla ( Fig. 18-17 , B).
▪
Postinsertion view of maxilla ( Fig. 18-17 , C).
▪
Postinsertion view of right mandible ( Fig. 18-17 , D).
▪
Postinsertion view of left mandible ( Fig. 18-17 , E).
▪
Postoperative radiograph. Note symmetry of plate/ blade form positioning. Note endodontic

stabilizer at tooth No. 23 ( Fig. 18-17 , F).
▪ Postoperative view of maxillary restoration ( Fig. 18-17 , G).
Figure 18-17
Figure 18-17
CASE 18
Courtesy Keisuke Wada, Nagoya, Japan
Case as Presented
Female patient in her teens. Unilateral cleft lip and maxillary alveolus. Congenitally absent lateral
incisor.

Maxillary four-unit porcelain-to-metal fixed prosthesis, with adjacent cuspid and both central
incisors as abutments and lateral incisor pontic.

Implant
Augmented lateral incisor area implanted with screw-type root form implant (Nobel Biocare).
Augmentation
Autogenous bone from mandibular symphysis.
Prosthesis
Crown of acrylic baked to metal coping.
Figures
▪ Preoperative view of maxillary congenitally missing lateral incisor ( Fig. 18-18 , A).
▪ Preoperative occlusal radiograph. Note lack of bone density in area of missing lateral incisor

( Fig. 18-18 , B).
▪ Postoperative occlusal radiograph showing autogenous bone augmentation and its

stabilization splint ( Fig. 18-18 , C).
▪ Postoperative view of final restoration in position ( Fig. 18-18 , D).
▪ Postoperative radiograph of restored implant ( Fig. 18-18 , E).
Figure 18-18
Figure 18-18
CASE 19
Courtesy Alain Ruet, Vaugneray, France
Case as Presented
Male patient in his 60s. Edentulous maxilla. Edentulous mandible. Abundant available bone.

Implants
In maxilla, six self-tapping root form implants (Nobel Biocare/Steri-Oss). In mandible, four self-
tapping root form implants (Nobel Biocare/Steri-Oss).
Prostheses
Maxillary splinting mechanism with provision for spherical attachments to offer retention for
maxillary overdenture. Mandibular splinting mechanism with provision for spherical attachments
to offer retention for mandibular overdenture.
Figures
▪ Preoperative radiograph. Note abundance of available bone ( Fig. 18-19 , A).
▪ Postoperative view of maxilla and mandible with implant splinting mechanisms and their

spherical attachments in position ( Fig. 18-19 , B).
▪ Postoperative view of tissue surface of maxillary overdenture showing spherical

attachments in position ( Fig. 18-19 , C).
▪ Postoperative view of tissue surface of mandibular overdenture showing spherical

attachments in position ( Fig. 18-19 , D).
▪ Completed prostheses in position ( Fig. 18-19 , E).
▪ Postoperative radiographs showing 10 well-placed root forms implants ( Fig. 18-19 , F).
Figure 18-19
CASE 20
Courtesy Naoki Nishihama, Amagasaki, Japan

Case as Presented
Male patient in his 40s. Edentulous except for one maxillary and three mandibular molars with
irreversible periodontal involvement.

Implants
Maxillary total subperiosteal implant. Five mandibular screw-type root form implants (ITI).
Prostheses
Maxillary complete-arch acrylic-to-metal fixed prosthesis. Mandibular splinted retention

mechanism with semi-fixed overdenture.
Figures

▪ Postoperative radiograph ( Fig. 18-20 , B).
Figure 18-20
Figure 18-20
CASE 21
Courtesy Joel Rosenlicht, Manchester, Connecticut
Case as Presented
Male patient in his 50s. Totally edentulous maxilla, resorbed ridges. Mandible with six anterior
teeth and serviceable bilateral partial removable denture.
Maxillary total removable denture.

Bone Enhancement
Bilateral subantral augmentation.

Implants
Eight maxillary screw-type root form implants (Nobel Biocare/Steri-Oss).
Prostheses
Maxillary complete-arch porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative view of edentulous maxilla ( Fig. 18-21 , A).

▪ Postoperative view of maxillary complete-arch porcelain-to-metal fixed prosthesis in position

( Fig. 18-21 , C).
▪ Postoperative radiograph. Note extensive subantral augmentation ( Fig. 18-21 , D).
Figure 18-21
Figure 18-21
CASE 22
Courtesy Terry Reynolds, Atlanta, Georgia
Case as Presented
Female patient in her 40s. Edentulous maxilla. Mandibular natural dentition.

Implant
Maxillary total subperiosteal implant.
Prosthesis
Complete-arch fixed prosthesis, acrylic baked to substructure.
Figures
▪ Preoperative view of edentulous maxilla ( Fig. 18-22 , A).

▪ Postoperative view of maxillary prosthesis in position ( Fig. 18-22 , B).
▪ Postoperative radiograph. Maxillary total subperiosteal implant with four individual abutment

heads ( Fig. 18-22 , C).
Figure 18-22
Figure 18-22
CASE 23
Courtesy Richard Borgner, St. Petersburg, Florida
Case as Presented
Male patient in his 70s. All maxillary teeth show irreversible periodontal involvement and require
removal. In mandible, except for right cuspid and central incisor and left cuspid and premolars,
remaining teeth require removal.
Following removal of all teeth unable to be retained, maxillary total removable maxillary denture
and mandibular partial removable denture.

Bone Enhancement
Maxillary bilateral subantral augmentation.
Implants
In maxilla, eight root form implants (Suncoast Dental). In mandible, two screw-type root form
implants (Suncoast Dental), two custom-made plate/blade form implants.
Prostheses
Maxillary and mandibular complete-arch porcelain-to-metal fixed prostheses.
Figures

▪ Postoperative view of maxillary complete-arch fixed prosthesis in position ( Fig. 18-23 , B).
▪ Postoperative view of mandibular complete-arch fixed prosthesis in position ( Fig. 18-23 ,

C).
▪ Postoperative radiograph. Note bilateral subantral augmentation ( Fig. 18-23 , D).
Figure 18-23
Figure 18-23
CASE 24
Courtesy Edward Mills, Atlanta, Georgia
Case as Presented
Female patient in her 50s. Edentulous maxilla showing moderate to advanced atrophy.
Edentulous mandible showing severe atrophy. Loss of some vertical dimension. Obvious loss of
facial contours. Unsatisfactory total removable dentures.
Maxillary and mandibular total removable dentures. Prognosis poor.

Bone Enhancement
In maxilla, radiated cortical bone for bilateral subantral augmentation. In mandible, autogenous
cranial bone graft to improve alveolar ridge. Repositioned and decompressed dehisced alveolar
nerve.
Implants
In maxilla, nine screw-type root form implants (Nobel Biocare/Steri-Oss). In mandible, total
subperiosteal implant.
Prostheses
Maxillary porcelain-to-metal fixed prostheses. Mandibular semi-fixed overdenture.
Figures
▪ Preoperative view of patient. Note aged appearance ( Fig. 18-24 , A).
▪ Preoperative radiograph. Note severe mandibular atrophy ( Fig. 18-24 , B).
▪ Preoperative lateral skull radiograph. Note severe mandibular atrophy ( Fig. 18-24 , C).
▪ Postoperative view of esthetics ( Fig. 18-24 , D).
▪ Postoperative view of prostheses in position ( Fig. 18-24 , E).
▪ Postoperative radiograph of restored maxilla and man-dible ( Fig. 18-24 , F).
Figure 18-24
Figure 18-24
CASE 25
Case as Presented
Female patient in her 70s. Edentulous maxilla. Six anterior teeth in mandible, with abundant
available bone in right and left posterior.

Implants
Intramucosal inserts (Oratronics) fastened to tissue surface of maxillary total denture. In

mandible, plate/blade form implants posteriorly (Oratronics), supplemented on left side by one-
stage spiral implant (Oratronics).
Prostheses
Maxillary total removable denture with intramucosal inserts. Mandibular complete-arch porcelain-
to-metal fixed prosthesis supported by two plate/blade form implants, one spiral implant, and
natural co-abutments.
Figures

▪ Immediate postinsertion radiograph ( Fig. 18-25 , B).
▪ Postoperative radiograph after restoration ( Fig. 18-25 , C).
Figure 18-25
Figure 18-25
CASE 26
Courtesy Takaharu Shimizu, Kobe, Japan
Case as Presented
Female patient in her 60s. Partially edentulous mandible.
Mandibular partial removable denture.

Implants
Four endosseous root form implants (ITI) joined to four natural co-abutments for additional
support.
Prosthesis
Mandibular 13-unit porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative view of mandible ( Fig. 18-26 , A).
▪ Preoperative radiograph. Adequate mandibular available bone ( Fig. 18-26 , B).
▪ Postoperative radiograph. Interesting case of root forms acting as co-abutments with teeth (

Fig. 18-26 , C).
Figure 18-26
Figure 18-26
CASE 27
Courtesy David Vassos, Edmonton, Alberta, Canada
Case as Presented
Male patient in his 60s. Mandible, previously treated, presents with six anterior teeth and four-unit
porcelain-to-metal fixed prosthesis totally supported by screw-type root form implants on each
side. Maxilla edentulous, with very little available bone under sinuses.

Bone Enhancement
Maxillary bilateral subantral augmentation using human irradiated bone and calcium sulfate,
initially protected by resorbable barrier membrane.
Implants
Fourteen screw-type root form implants (Nobel Biocare/ Steri-Oss).
Prosthesis
Fourteen individual porcelain-to-metal fixed crowns.
Figures
▪ Preoperative radiograph showing limited available bone in maxilla and previously restored

mandible ( Fig. 18-27 , A).
▪ Postoperative subantral augmentation radiograph showing substantial increase in available

bone for root form placement ( Fig. 18-27 , B).
▪ Postoperative view of crowns in position in maxilla ( Fig. 18-27 , C).
Figure 18-27
Figure 18-27
CASE 28
Case as Presented
Female patient in her 60s. Edentulous maxilla. Mandibular posterior edentulism; six anterior teeth
and left first premolar are satisfactory.

Implants
Posterior ramus blade on each side, premolar area plate/ blade form on each side (Pacific
Dental).
Prostheses
Mandibular bilateral porcelain-to-metal fixed prostheses each with one natural co-abutment and
two implants as support.
Figures

▪ Postoperative view of completed prostheses ( Fig. 18-28 , B).
▪ Postoperative radiograph showing two posterior five-unit fixed prostheses ( Fig. 18-28 , C).
Figure 18-28
Figure 18-28
CASE 29
Courtesy Joe F. Warriner, Oklahoma City, Oklahoma
Case as Presented
Female patient in her 40s. Partially edentulous maxilla, shallow available bone under right sinus.
Partially edentulous mandible, severely resorbed right posterior alveolar ridge, adequate available
bone left alveolar ridge.
Maxillary partial removable denture. Mandibular partial removable denture.

Implants
Maxillary left one-stage screw-type root form implant (Parc Dental Research), right posterior
plate/blade form implant (Pacific Dental). Mandibular left posterior ramus blade implant (Pacific
Dental), right posterior unilateral subperi-osteal implant.
Prostheses
Maxillary complete-arch porcelain-to-metal fixed prosthesis. Mandibular complete-arch porcelain-

to-metal fixed prosthesis.
Figures
▪ Preoperative radiograph. Note variations in residual alveolar ridge available bone in each

arch ( Fig. 18-29 , A).
▪ Postoperative view of mandibular complete-arch fixed prosthesis ( Fig. 18-29 , B).
▪ Postoperative view of right sides of maxillary and man-dibular complete-arch fixed

prostheses ( Fig. 18-29 , C).
▪ Postoperative radiograph. Note that all implants are functioning in osteopreserved mode of

tissue integration, including maxillary one-stage screw-type root form ( Fig. 18-29 , D).
Figure 18-29
Figure 18-29
CASE 30
Case as Presented
Two complete-arch porcelain-to-metal fixed prostheses in need of replacement. Several natural

teeth and one plate/ blade form implant diagnosed for removal.

Removal of maxillary right third molar and three pontics anterior to it, and left lateral incisor.
Insertion of maxillary partial removable denture. Removal of mandibular right premolar and left
premolar and plate/blade form implant. Insertion of mandibular partial removable denture.

Bone Enhancement
Maxillary right subantral augmentation to accommodate plate form under sinus.
Implants
In maxilla, right posterior plate form implant (Omni) and root form implant (Steri-Oss) in left lateral
incisor area. In mandible, custom-made plate form on each side. Endodontic stabilizers for right
cuspid and first premolar.
Prostheses
Maxillary and mandibular complete-arch porcelain-to-metal fixed prostheses.
Figures

▪ Postoperative radiograph. Note four varieties of endosteal implants ( Fig. 18-30 , B).
Figure 18-30
Figure 18-30
CASE 31
Courtesy Thomas Chess, South Pasadena, California
Case as Presented
Female patient in her 60s. Edentulous maxilla except for six anterior teeth. Edentulous mandible
except for six anterior teeth and impacted left third molar.
Maxillary and mandibular bilateral partial removable dentures.

Implants
Six root forms in maxilla and six root forms in mandible (Bicon), splinted to natural co-abutments.
Prostheses
Two complete-arch porcelain-to-metal fixed prostheses.
Figures
▪ Preoperative radiograph. Note available bone ( Fig. 18-31 , A).

▪ Postoperative radiograph. Note relationship of maxillary root forms to sinuses ( Fig. 18-31 ,

B).
Figure 18-31
Figure 18-31
CASE 32
Courtesy James L. Rutkowski, Clarion, Pennsylvania
Case as Presented
Female patient in her 70s. Edentulous maxilla. Posterior edentulism in mandible, with acceptable
remaining teeth between right premolar and left lateral incisor.

Implants
Mandibular circumferential subperiosteal implant.
Prostheses
Maxillary total removable denture. Mandibular complete-arch fixed prosthesis.
Figures

▪ Postoperative view of prosthesis in position ( Fig. 18-32 , B).
▪ Postoperative radiograph ( Fig. 18-32 , C).
Figure 18-32
Figure 18-32
CASE 33
Courtesy Yasunori Hotta, Nagoya, Japan
Case as Presented
Female patient in her 50s. In maxilla, left and right second molars are in position, as well as right
central incisor, left central and lateral incisors and cuspid. In mandible, left premolars and molars
and right first molar are missing. Interocclusal clearance is minimal on both sides.
Maxillary and mandibular partial removable dentures. Perhaps limited fixed prostheses in
addition.

Bone Enhancement
Autogenous bone slurry harvested from bone filter, demin-eralized freeze-dried bone allograft and
resorbable HA.
Implants
Screw-type and press-fit-type root forms (ITI, IMZ, Ankylos).
Prostheses
Maxillary complete-arch porcelain-to-metal fixed prosthesis. Mandibular three-unit fixed bridge

supported by implant abutments.
Figures
▪ Preoperative view of maxilla ( Fig. 18-33 , A).

▪ Preoperative view of mandible ( Fig. 18-33 , B).
▪ Preoperative radiograph ( Fig. 18-33 , C).
▪ Postoperative view of completed prostheses. Note esthetics ( Fig. 18-33 , D).
▪ Postoperative view of maxilla ( Fig. 18-33 , E).
▪ Postoperative radiograph ( Fig. 18-33 , F).
Figure 18-33
Figure 18-33
CASE 34
Courtesy Naoki Nishihama, Amagasaki, Japan
Case as Presented
Male patient in his 40s. Several acceptable maxillary teeth present. Central and lateral incisors,
and left cuspid and first premolar are missing. Right mandible is edentulous distal to cuspid, with
distal ridge resorption. Six acceptable anterior teeth are present. Left posterior mandible reveals
failing four-unit fixed prosthesis supported by four screw-type root forms.
Maxillary partial removable denture. Removal of left implant-supported fixed prosthesis.

Mandibular partial removable denture.
Implants
Maxillary anterior subperiosteal implant. Mandibular right unilateral subperiosteal implant.

Mandibular left unilateral subperiosteal implant.
Prostheses
Maxillary complete-arch acrylic-to-metal fixed prosthesis supported by implant and natural co-
abutments. Mand-ibular complete-arch acrylic-to-metal fixed prosthesis supported by implant and
natural co-abutments.
Figures

▪ Postoperative view of maxillary restoration in position ( Fig. 18-34 , B).
▪ Postoperative view of maxillary and mandibular restorations in position. Note ridge lapping

of maxillary incisors ( Fig. 18-34 , C).
Figure 18-34
Figure 18-34
CASE 35
Courtesy Eiichi Kojima, Tokyo, Japan

Case as Presented
Female patient in her 50s. Edentulous maxilla. Edentulous mandible except right central incisor,
left incisors, and cuspid, which are acceptable. Ample available bone above inferior alveolar
canal on each side, and in right first premolar cuspid and lateral incisor areas.

Implants
In mandible, two plate/blade form implants posteriorly, and one plate/blade form in the right
cuspid area (Oratronics).
Prostheses
Maxillary total removable denture with metal palate. Mandibular 14-unit complete-arch porcelain-
to-metal fixed prosthesis.
Figures
▪ Preoperative view of mandible showing four natural co-abutments ( Fig. 18-35 , A).
▪ Postoperative view of prepared natural co-abutments and healed implants ( Fig. 18-35 , C).
▪ Postoperative view of occlusal aspect of complete-arch fixed prosthesis ( Fig. 18-35 , D).
▪ Postoperative view. Note mandibular posterior ridge lapping ( Fig. 18-35 , E).
▪ Postoperative radiograph ( Fig. 18-35 , F).
Figure 18-35
Figure 18-35
CASE 36
Dr. Yasunori Hotta, Nagoya, Japan
Case as Presented
Male patient in his 50s. Edentulous maxilla except for left second molar and central incisor, and
right central and lateral incisors and cuspid. Anterior maxillary teeth are irreversibly periodontally
involved. Posterior interocclusal clearance is minimal on each side. In mandible, right molar area
is edentulous. Available bone is adequate.
Following removal of all remaining maxillary teeth, total removable denture. Partial removable
denture in mandible.
Bone Enhancement
Autogenous bone graft slurry harvested from bone filter.
Implants
Twelve screw-type root form implants (ITI).
Prostheses
Maxillary complete-arch porcelain-to-metal fixed prosthesis. Mandibular left four-unit porcelain-to-

metal fixed prosthesis.
Figures

▪ Postoperative view of maxilla ( Fig. 18-36 , C).
Figure 18-36
Figure 18-36
CASE 37
Courtesy Alain Ruet, Vaugneray, France
Case as Presented
Male patient in his 50s. Maxillary edentulism from right central incisor through entire left side.
Mandibular arch well restored.
Maxillary partial removable denture.

Implants
Five root form implants in anterior and left maxilla (Nobel Biocare/Steri-Oss).
Prosthesis
Seven-unit porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative left quadrant radiograph ( Fig. 18-37 , A).

▪ Postimplant insertion view of splinting mechanism with embedded spherical attachments for

retention ( Fig. 18-37 , B).
▪ Postoperative occlusal view of inserted prosthesis ( Fig. 18-37 , C).
▪ Esthetic result ( Fig. 18-37 , D).
▪ Postoperative left anterior radiograph ( Fig. 18-37 , E).
Figure 18-37
Figure 18-37
CASE 38
Courtesy James L. Rutkowski, Clarion, Pennsylvania
Case as Presented
Female patient in her 50s. In maxilla, teeth present and acceptable from left second premolar to
right cuspid. Some available bone under sinus on each side. Mandible presents with many teeth
and no need of implants for restoration.
Maxillary partial removable denture. Mandibular fixed prostheses.

Bone Enhancement
Maxillary bilateral subantral augmentation using freeze-dried demineralized bone.
Implants
Five screw-type root form implants (Paragon).
Prostheses
In maxilla, bilateral porcelain-to-metal fixed prostheses, each with one natural co-abutment. In
mandible, conventional bilateral fixed prostheses.
Figures

Figure 18-38
Figure 18-38
CASE 39
Courtesy Firdaus S. Jafri, Carol Stream, Illinois
Case as Presented
Male patient in his 50s. Severe generalized periodontitis. Many remaining teeth in mandible and
maxilla.
Removal of remaining maxillary teeth and insertion of total removable denture. Removal of
several mandibular teeth, and insertion of partial removable denture.

Implants
Following removal and healing of all remaining maxillary teeth except cuspids, insertion of
circumferential subperi-osteal. Following removal of remaining mandibular teeth except right
cuspid and first premolar, and left cuspid, premolars, and first molar, insertion of circumferential
subperiosteal implant.
Prostheses
Using remaining teeth in each arch as natural co-abutments with implant abutments, two
complete-arch porcelain-to-metal fixed prostheses were fabricated and inserted.
Figures
▪ Preoperative postextraction radiograph ( Fig. 18-39 , A).

▪ Postoperative radiograph with final prostheses in position ( Fig. 18-39 , B).
Figure 18-39
Figure 18-39
CASE 40
Courtesy Takaharu Shimizu, Kobe, Japan
Case as Presented
Male patient in his 70s. Loss of maxillary right central incisor. Narrow alveolar ridge width.
Four-unit fixed prosthesis, with right lateral incisor and left central and lateral incisor abutments,
and right central incisor pontic.

Implant
Maxillary right central incisor area root form (ITI) after ridge expansion.
Prosthesis
Right maxillary central incisor porcelain-to-metal crown.
Figures
▪ Preoperative view of anterior maxilla ( Fig. 18-40 , A).

▪ Postoperative view of completed restoration ( Fig. 18-40 , C).
Figure 18-40
Figure 18-40
CASE 41
Courtesy Terry Reynolds, Atlanta, Georgia
Case as Presented
Female patient in her 40s. In maxilla, six anterior teeth missing. In mandible, right first and
second molars missing.

Maxillary 12-unit porcelain-to-metal fixed prosthesis, from right first molar to left first molar, with
six anterior pontics. Mandibular right five-unit porcelain-to-metal fixed prosthesis.

Implants
Maxillary anterior interdental subperiosteal implant to provide abutments in edentulous area.

Mandibular plate/blade form as pier abutment for fixed prosthesis.
Prosthesis
Ten-unit porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative view of edentulous area at anterior maxilla ( Fig. 18-41 , A).
▪ Postoperative view of porcelain-to-metal fixed prosthesis in position. Note ridge lapping (

Fig. 18-41 , B).
▪ Postoperative view of prosthesis with lips in repose ( Fig. 18-41 , C).
▪ Postoperative radiograph. Note anterior maxillary subperiosteal implant, and posterior pier

abutment plate/ blade form implant ( Fig. 18-41 , D).
Figure 18-41
Figure 18-41
CASE 42
Courtesy Richard Borgner, St. Petersburg, Florida
Case as Presented
Male patient in his 50s. Left maxillary incisor missing. Adjacent teeth have not had prior dental
restorations. Occlusion is atypical. Diastemas present.
Four-unit porcelain-to-metal fixed prosthesis, using right lateral and central incisors and left lateral
incisors as abutments, with left central incisor restored as pontic.

Implant
One root form implant (Suncoast Dental).
Prosthesis
Individual porcelain-to-metal fixed crown.
Figures
▪ Preoperative frontal view of edentulous area of maxilla ( Fig. 18-42 , A).
▪ Preoperative incisal view of edentulous area of maxilla ( Fig. 18-42 , B).
▪ Preoperative radiograph ( Fig. 18-42 , C).
▪ Postoperative view showing healed implant in position ( Fig. 18-42 , D).
▪ Postoperative view of completed restoration in position ( Fig. 18-42 , E).
▪ Postoperative segmented radiograph showing implant positioning ( Fig. 18-42 , F).
Figure 18-42
CASE 43
Courtesy Alfred Duke Heller, Worthington, Ohio
Case as Presented
Female patient in her 30s. Maxillary arch intact except for congenitally missing right and left
lateral incisors. Intact and acceptable mandibular arch.

Maxillary six-unit anterior porcelain-to-metal fixed prosthesis using cuspids and central incisors as
abutments, with lateral incisor pontics.

Implants
Two root form implants (Miter and Bicon).
Prostheses
Two individual freestanding crowns each supported by root form implant. Lingual tabs or wings
against lingual surfaces of cuspids and central incisors to promote stability of position.
Figures
▪ Postoperative view of crowns in position. Note esthetic result ( Fig. 18-43 , A).
▪ Postoperative radiograph of right lateral incisor area ( Fig. 18-43 , B).
▪ Postoperative radiograph of left lateral incisor area ( Fig. 18-43 , C).
Figure 18-43
Figure 18-43
CASE 44
Case as Presented
Male patient in his 40s. Edentulous maxilla except for left cuspid, second premolar, and second
molar.

Maxillary left five-unit partial fixed prosthesis. Maxillary partial removable denture. Mandibular
unilateral partial removable denture.

Implants
Four osteointegrated two-stage plate/blade form implants (Oratronics) in anterior and right
maxilla. One osteopreserved one-stage plate/blade form implant (Oratronics) in posterior left
mandible.
Prostheses
Maxillary nine-unit porcelain-to-metal fixed prosthesis extending from left lateral incisor to right
second molar supported by implants. Mandibular four-unit porcelain-to-metal fixed prosthesis.
Figures

▪ Postoperative view of completed prostheses inserted ( Fig. 18-44 , C).
▪ Postoperative radiograph following implant insertions ( Fig. 18-44 , D).
Figure 18-44
Figure 18-44
CASE 45
Case as Presented
Female patient in her 20s. Left maxilla edentulous distal to cuspid. Except cuspids, all remaining
mandibular teeth require removal.
Maxillary partial removable denture. Mandibular partial removable denture.

Implants
In left maxilla, unilateral subperiosteal implant. In mandible, six one-stage plate/blade form
implants (Oratronics).
Prostheses
Maxillary 14-unit complete-arch porcelain-to-metal fixed prosthesis. In mandible, complete-arch

porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative view following tooth removals ( Fig. 18-45 , A).

▪ Preoperative radiograph before tooth removal ( Fig. 18-45 , B).
▪ Postoperative view of completed prostheses ( Fig. 18-45 , C).
Figure 18-45
Figure 18-45
CASE 46
Courtesy Firdaus S. Jafri, Carol Stream, Illinois
Case as Presented
Male patient in his 50s. Remaining maxillary teeth are both premolars, right second premolar and
cuspid, and left cuspid. All mandibular teeth present except left molars.
Remove remaining maxillary teeth. Maxillary total removable denture.

Implants
Following removal of right second premolar and left first premolar, maxillary circumferential
subperiosteal. After insertion, maxillary right and left cuspid and left second premolar were
removed. Three endosseous root form implants inserted (Lifecore).
Bone Enhancement
Tricalcium phosphate (TCP) and demineralized freeze-dried bone.

Prostheses
Complete-arch porcelain-to-metal fixed prosthesis.
Figures
▪ Preoperative radiograph. Note shallow available bone under sinuses ( Fig. 18-46 , A).
▪ Postoperative radiograph following removal of three remaining teeth and insertion of three

root form implants ( Fig. 18-46 , B).
Figure 18-46
Figure 18-46
CASE 47
Courtesy Emile Martin, Syracuse, New York
Case as Presented
Male patient in his 40s. Total edentulism in maxilla and mandible. Patient cannot function
adequately with man-dibular total removable denture.

Implants
Mandibular total subperiosteal implant fabricated on CAT scan model.
Prosthesis
Maxillary total removable denture. Mandibular complete semi-fixed overdenture retained by

combination of magnets and clips.
Figures
▪
Preoperative view of mandible ( Fig. 18-47 , A).
▪
Preoperative radiograph ( Fig. 18-47 , B).
▪
CAT scan model ( Fig. 18-47 , C).
▪
Postoperative view of mandible. Note four magnetic retention devices ( Fig. 18-47 , D).
▪
View of undersurface of overdenture showing four magnetic retention devices and two

plastic clips ( Fig. 18-47 , E).
▪ Postoperative view of prosthesis in position. Note cutter bars posteriorly ( Fig. 18-47 , F).
▪ Postoperative radiograph ( Fig. 18-47 , G).
Figure 18-47
Figure 18-47
CASE 48
Courtesy Emile Martin, Syracuse, New York
Case as Presented
Male patient in his 40s. Maxilla edentulous on right side distal to cuspid. Maxilla left premolars
and second and third molars missing. One millimeter of bone present inferior to right sinus. Left
mandible missing second premolar and molars. Right mandible missing first premolar and second
and third molars. Available bone is adequate in mandible.
Following required tooth removals, endodontic and operative treatment, removable maxillary and
mandibular partial removable dentures.

Bone Enhancement
Subantral augmentation of left maxilla, using demineralized freeze-dried bone allograft, barrier
membrane (Gortex).
Implants
In maxilla, right unilateral subperiosteal, left four splinted screw-type root forms. In mandible,
plate/blade form, left distal (Miter).
Prostheses
Maxillary porcelain-to-metal fixed prosthesis on right with natural co-abutments, and on left, four-
unit implantsupported splint and individual crown. Mandibular left five-unit fixed prosthesis with
natural co-abutments, and four-unit conventional fixed prosthesis on right.
Figures

Figure 18-48
Figure 18-48

Chapter 18 - Examples of Intermediate and Advanced Cases

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Chapter 18 - Examples of Intermediate and Advanced Cases

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– Examples of Intermediate and Advanced

INTERMEDIATE AND ADVANCED CASES

Courtesy Jerry Soderstrom, Rapid City, South Dakota

Probable Conventional Dentistry Treatment Plan

Maxillary total removable denture. Mandibular total removable denture.

Implant Dentistry Treatment Plan

Ramus frame implant (Pacific Dental).

Courtesy Edward A. Amet, Overland Park, Kansas

Probable Conventional Dentistry Treatment Plan

Maxillary total removable denture. Mandibular total removable denture.

Implant Dentistry Treatment Plan

▪ Preoperative view of edentulous mandible ( Fig. 18-2 , A).

Probable Conventional Dentistry Treatment Plan

Implant Dentistry Plan

In maxilla, complete-arch porcelain-to-metal fixed prosthesis supported by plate/blade form

Courtesy Walter Knouse, Lumberville, Pennsylvania

Probable Conventional Dentistry Treatment Plan

Maxillary partial removable denture. Mandibular total re-movable denture.

Implant Dentistry Treatment Plan

Maxillary partial-arch porcelain-to-metal fixed prostheses supported by implant and tooth

Courtesy Ralph Roberts, Rio Dell, California

Probable Conventional Dentistry Treatment Plan

Maxillary and mandibular total removable dentures.

Implant Dentistry Treatment Plan

Ramus frame implant (Pacific Dental).

Maxillary total removable denture. Mandibular semi-fixed overdenture.

Courtesy Keisuke Wada, Nagoya, Japan

Probable Conventional Dentistry Treatment Plan

Implant Dentistry Treatment Plan

Five screw-type root form implants (Nobel Biocare) in anterior mandible.

Courtesy Katsura Omura, Kyoto, Japan

Probable Conventional Dentistry Treatment Plan

Maxillary partial removable denture. Mandibular total removable denture.

Implant Dentistry Treatment Plan

Five plate/blade form implants (Oratronics).

Mandibular porcelain-to-metal 14-unit complete-arch fixed prosthesis.

▪ Preoperative view of edentulous mandible ( Fig. 18-7 , A).

Courtesy Eiichi Kojima, Tokyo, Japan

Edentulous maxilla. Edentulous mandible.

Probable Conventional Dentistry Treatment Plan

Maxillary and mandibular total removable dentures.

Implant Dentistry Treatment Plan

Mandibular total subperiosteal implant.

Maxillary total removable denture. Mandibular semi-fixed overdenture.

Female patient in her 60s. Edentulous maxilla. Edentulous mandible.

Probable Conventional Dentistry Treatment Plan

Maxillary total removable denture. Mandibular total removable denture.

Implant Dentistry Treatment Plan

Complete-arch reinforced acrylic fixed prosthesis.

▪ Preoperative radiograph ( Fig. 18-9 , A).

Courtesy Jerry Soderstrom, Rapid City, South Dakota

Female patient in her 70s. Edentulous maxilla. Edentulous mandible.

Probable Conventional Dentistry Treatment Plan

Implant Dentistry Treatment Plan

Custom-made mandibular tripodal subperiosteal, fabricated on model created with aid of

Courtesy Edward M. Amet, Overland Park, Kansas

Probable Conventional Dentistry Treatment Plan

Maxillary total removable denture. Mandibular total removable denture.

Implant Dentistry Treatment Plan

Maxillary total removable denture. Mandibular semi-fixed overdenture

▪ Preoperative view of edentulous mandible ( Fig. 18-11 , A).

Courtesy Ralph Roberts, Rio Dell, California