A 66 years-old female with no systemic conditions came to MALO CLINIC Lisbon for an evaluation appointment. The patient’s main concern was “having fixed teeth” after 30 years using dentures and the proposed treatment plan was the MALO CLINIC Protocol rehabilitation for both upper and lower jaw.

A muco-periosteal flap was retracted allowing the identification of all anatomical limits along the process. Implants osteotomy was conducted following the drills sequence according to the bone density, aiming for an underpreparation protocol in order to achieve an adequate primary stability for immediate function.

The surgical procedure was performed according to the MALO CLINIC Protocol. In both jaws, two straight anterior implants and two tilted implants (NobelSpeedy Groovy® RP, Nobel Biocare AB) were placed. The bone density was qualified as medium in the upper jaw and dense in the lower jaw and the primary stability obtained was more than 50 N/cm in all implants.The length of the implants used was 15 mm except on the implants 12 and 22 which had 10 mm of length. Multiunit abutments of 30o 4 mm (Nobel Biocare AB) with 15 N/cm torque were adapted to the posterior angulated implants and to the anterior implants straight multiunit abutments of 2mm (Nobel Biocare AB) with 35 N/cm torque were placed. Silk suture was used to stabilize the flap, immediately proceeding with the impressions. Once the impression set was removed, healing caps were placed (Nobel Biocare AB) and a post-operative orthopantomography was done.

Provisional implant supported fixed prosthesis of high-density acrylic resin (PalaXpress®Ultra; Heraeus Kulzer GmbH) and acrylic resin prosthetic teeth (Anterior –Pala® Premium teeth; Posterior- Pala® Mondial teeth, Heraeus Kulzer GmbH) with titanium cylinders (NobelBiocare AB) were manufactured at the dental laboratory and delivered on the same day of the surgery, fulfilling the esthetic and functional requirements. After six months the final prostheses were placed: metal-acrylic implant supported fixed prostheses with a titanium framework (Nobel Procera titanium framework®; Nobel Biocare AB) and acrylic resin prosthetic teeth (Anterior –Pala® Premium teeth; Posterior-Pala® Mondial teeth, Heraeus Kulzer GmbH) were used to replace the provisional prostheses.

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Oral Surgeon- Armando Lopes, DDS, MSc
Prosthodontist – Joao Nunes, DDS
Laboratory – MALO CLINIC Ceramics

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