Patient Concern: A patient presented to our clinic with the complaint of ill-fitting upper complete denture and lower removable partial denture, along with difficulty chewing food. These issues significantly impacted the patient’s quality of life, diet, and confidence.
Clinical Examination:
- Maxilla: Completely edentulous
- Mandible: Missing posterior molars on both left and right sides
- Existing prosthesis: Poorly fitting complete denture in the maxilla and unstable lower partial denture
Medical History:
- Known case of Diabetes Mellitus and Hypertension (under control)
- On long-term aspirin therapy for cardiovascular health
Investigations: A CBCT scan was advised to evaluate the bone quality and quantity for implant placement in both jaws. The scan revealed adequate bone height and width for implant placement in the anterior maxilla and bilateral posterior mandible.
Treatment Plan:
- Full arch implant-supported fixed prosthesis in the maxilla
- Implant placement in posterior mandible (left and right) to restore occlusion and function
- Physician clearance was obtained due to systemic conditions
- Aspirin was stopped 3 days prior to surgery on physician’s advice
Surgical Procedure: Dental Implant Placement
Day of Surgery: After proper asepsis and disinfection, the procedure was carried out under local anesthesia using lidocaine with epinephrine.
Step-by-Step Surgical Protocol:
1. Patient Preparation:
- Extraoral and intraoral disinfection
- Draping and sterile field maintained
- Pre-surgical rinse with 0.2% chlorhexidine
2. Maxillary Implant Placement (Full Arch):
- Mid-crestal incision made on edentulous ridge
- Full-thickness mucoperiosteal flap raised to expose the underlying bone
- Sites marked according to the CBCT-based surgical guide (typically 4–6 implants)
- Sequential osteotomy drills used to prepare the implant sites at slow speed with copious irrigation
- Implants placed (usually 3.5–4.2 mm diameter and 10–13 mm length) with primary stability achieved (>35 Ncm)
- Cover screws placed and flap sutured with 3-0 non-resorbable sutures
3. Mandibular Posterior Implant Placement (Left & Right):
- Site infiltration anesthesia on both sides
- Crestal incision over the edentulous molar areas
- Flap reflection done to expose bone
- Implant osteotomy done sequentially
- Implants placed with torque control to ensure optimal primary stability
- Healing abutments placed where appropriate
- Flaps sutured carefully to ensure tension-free closure
Post-Operative Care:
- Antibiotics and anti-inflammatory medications prescribed
- Strict post-op instructions provided
- Patient advised soft diet for a week
- Aspirin resumed after 48 hours post-op as per physician’s advice
- Follow-up scheduled after 7 days for suture removal
- Further prosthetic phase to be planned after 3–4 months of healing