A 58-year-old patient presented with a terminal maxillary dentition, generalised mobility and a clear wish to avoid a removable provisional at any stage. The question was not whether implants were indicated, but whether the arch could be loaded on the day of surgery.<\/p>\n\n\n\n
Clinical examination showed grade II\u2013III mobility across the remaining maxillary teeth with 7\u20139 mm probing depths. CBCT demonstrated adequate anterior bone volume with pneumatised sinuses posteriorly. Critically, the patient\u2019s occlusal scheme and lip position were recorded before any extraction, so the prosthetic target was fixed before the surgical plan was drawn.<\/p>\n\n\n\n
Pre-operative photograph<\/strong>Full-face and intraoral seriesFig 1 \u2014 Pre-operative presentation. Note the incisal position relative to the resting lip.<\/p>\n\n\n\n Working backwards from the intended prosthesis, four implants were planned with posterior tilting to engage the anterior sinus wall and avoid grafting. A photogrammetry workflow was selected for impression capture, allowing an accurate framework record without a conventional impression on an unhealed surgical field.<\/p>\n\n\n\n CBCT planning view<\/strong>Cross-sectional and panoramic reconstructionFig 2 \u2014 Virtual planning. Implant axes were dictated by the restorative position.<\/p>\n\n\n\n Guide design<\/strong>Surgical guide, seated on boneFig 3 \u2014 The guide was designed for bone support following extraction.<\/p>\n\n\n\n Atraumatic extraction was followed by alveoloplasty to a flat, predictable platform. Osseodensification burs were used to preserve and compact bone at the osteotomy walls, producing insertion torques of 45\u201355 Ncm across all four fixtures \u2014 the threshold we require before committing to same-day loading.<\/p>\n\n\n\n Multi-unit abutments were placed intra-operatively, photogrammetry markers captured, and a milled provisional delivered the same afternoon. Total chair time was under six hours.<\/p>\n\n\n\n At 18 months all four implants remain stable with no measurable bone loss beyond the expected first-year remodelling. The definitive prosthesis was delivered at four months. The patient did not wear a removable appliance at any point.<\/p>\n","protected":false},"featured_media":52,"template":"","class_list":["post-1044","clinical_cases","type-clinical_cases","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"\nPlanning<\/h2>\n\n\n\n
Surgery and immediate loading<\/h2>\n\n\n\n
Outcome<\/h2>\n\n\n\n