Patient history:

Name: Claude - Age: 78 - Gender: male

Medical history : HTA ASA II

Dental history: loss of multiple teeth without being able to use a removable upper prosthesis due to the palatal torus, producing posterior lifting, leaving no occlusal support for feeding.

Reason for consultation: I want something fixed to be able to feed myself.

Diagnosis:

• Maxillary and mandibular partial edentulousness

• Periodontal diagnosis: Stage III chronic periodontitis, localized, Grade A.(Caton,2017)

Relevant clinical situations

• Fine Gingival Biotype.

• Collapse of the ridge Class II (Seibert,1983) Moderate (Allen,1985).

• Upper lip line: Tall smile.

• Ridge shape (Coscolla Rodriguez): U shape: Palatal and buccal faces in parallel position, provides a good "occlusal surface" and is the most favorable.

• Lekholm and Zarb (1985) Classification: Class C: Advanced anterior resorption of residual alveolar bone.

• Atwood Classification: Class V: Low well rounded in the anterior zone.- Class III: High well rounded in the right post zone.

treatment plan:

Multiple implants, All on Four technique with Neobiotech ISIII active implants + osseodensification with versah drills in posterior beds, ROG (Botis): Bone graft: non-resorbable xenograft (demineralized Bovine Bone without organic matrix) and Jason membrane stabilized with resorbable suture.

Implant with immediate load (temporal-definitive fixed) using upper prosthesis, installation of straight and angled pillars for temporary multiunic.

prosthetic duplicate and semi-strict surgical guide

definitive temporary prosthesis

Final hybrid prosthesis installed.