case_images: PMC5371219_01
case_images: Edentulous mandibular arch with knife-edge ridge.
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case_images: fig1
case_images: The mandibular arch was also U-shaped with large curvature and knife-edge ridges (Figure 1).
case_images: Cone beam computed tomography (CBCT) findings showing very thin coronal portion of the alveolar ridge.
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case_images: fig2
case_images: The CBCT scan revealed a very thin Class IV type of alveolar ridge (knife-edge) (Figure 2).
case_images: Alignment of the four implants' position.
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case_images: fig3
case_images: Conical Connection NP 3.5 mm x 13 mm implants (Nobel Biocare, USA) were planned at the interforaminal region of the mandibular anterior region (Figure 3). Cover screws were placed on the implants and minor bone grafting using demineralised bovine bone matrix (BioOss, Geistlich, Switzerland) and barrier membrane (BioGide, Geistlich, Switzerland) was done to cover exposed threads at the #42 implant area.
case_images: Three 5 mm healing abutments placed on the remaining implants.
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case_images: fig4
case_images: Subsequently, the failed implant was removed while 5 mm healing abutments replaced the cover screws of the other three implants (Figure 4).
case_images: The intaglio surface of the mandibular interim denture is relined.
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case_images: fig5
case_images: The soft lining material was removed from the intaglio surface and relined with a denture repair acrylic resin material (Rebase II, Tokuyama, Japan) (Figure 5).
case_images: The teeth setup in wax.
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case_images: fig6
case_images: ARH, Sweden) and the teeth setup was done (Figure 6). Another appointment for clinical try-in was done to check the aesthetics and occlusion for the patient. After the patient accepted the clinical try-in, the dentures were then brought back to the laboratory to have an occlusal silicone index fabricated to locate the position of the mandibular denture teeth (Figure 7).
case_images: Silicone index registering the occlusal position of the denture teeth.
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case_images: fig7
case_images: ARH, Sweden) and the teeth setup was done (Figure 6). Another appointment for clinical try-in was done to check the aesthetics and occlusion for the patient. After the patient accepted the clinical try-in, the dentures were then brought back to the laboratory to have an occlusal silicone index fabricated to locate the position of the mandibular denture teeth (Figure 7).
case_images: Wax denture base with the denture teeth removed.
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case_images: fig8
case_images: After the impression copings were screwed onto the implants and verified with radiographs for complete seating, the copings were joined together by lacing the floss across the copings in a figure of "8" and subsequently strengthened with autopolymerization resin (GC Pattern Resin, Japan). Three items were required for the Nobel Procera scan: (1) master cast model, (2) wax denture base with teeth setup, and (3) wax denture base without teeth setup (the intaglio surface of teeth) (Figure 8).
case_images: Design of the framework using the Nobel Procera software.
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case_images: fig9
case_images: Facility in Japan through the software itself. For this case, the process of scanning and designing the suprastructure was done using the Nobel Procera scanner and software (Figure 9) located at the dental centre's in-house laboratory; thus the design could be controlled by the clinician.
case_images: Milled implant framework tried in the mouth.
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case_images: fig10
case_images: The implant bar framework was then received and tried in the patient's mouth (Figure 10).
case_images: Final prosthesis in the mouth.
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case_images: fig11
case_images: The dentures were issued to the patient with accompanying home care instructions (Figure 11).