Full Mouth Denture Restoration over Immediate Loading Implants
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A 65-year-old, male patient sought dental treatment at IbomRio Dental Institute, Rio de Janeiro State, Brazil with a complaint of not being able to use his removable upper total prosthesis due to fit, making it difficult to eat correctly (Fig. 1). During the clinical exam, it was observed total edentulism on the maxilla, and partial absence of the posterior mandible teeth (Fig. 2). A correct oral hygiene instruction was performed, followed by digitalization of the upper and lower arch of the patient (Fig. 3A, 3B). After scanning, a photograph of the patient’s frontal smiling face was taken to simulate the smile (Fig. 4).
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Fig 1: Initial Smile
Fig. 2: Upper and lower intraoral pictures
 As the patient no longer wore the upper denture, a maxillary record base and wax rim were made to make the measurements of the vertical dimension of occlusion and the development of contours of the lips, in addition to aiding in orientation of the incisors and the occlusal plane that will be adopted for the new patient’s prosthesis confection. A photograph of the patient’s frontal facial smiling position with the base plate and the wax rim was taken (Fig. 5) in order to perform the 2D Smile Simulation which was used with one of the smile donator libraries from the DSDApp.
Fig. 3A + 3B: Upper and Lower digital Scanning 
Figure 4: Initial Smile
Fig. 5: patient smiling face with the base plate and the wax rim 
The patient was shown a smile simulation case presentation with before and after photos. Once shown the transformation, he was immediately appreciative and instantly approved the case (Fig. 6). 
The smile simulation was then converted to a 3D project for digital teeth mounting (Fig. 7). The designed 3D Project (which is a STL file) was then exported from the app and imported to a CAD software (Fig. 8) to create and 3D print (using CAM software) a stent surgical guide (Fig. 9). 
Fig. 7: 3D digital teeth mounting 
Fig. 8: 3D digital waxing - CBCT Stent - Guided Surgery
Fig. 9: Printed CBCT Stent - Guided Surgery
Two CBCTs (Cone Beam Computed Tomography) were taken to reference the position of the future implants. The first one was the patient using the stent surgical guide, and the second was of the stent surgical guide itself (Fig. 10A, 10B, 10C). These images were joined through a planning software, and the files along with the 3D digital wax were sent to the DSD Planning Center. 
Fig 10A: CBCT of Patient
Fig 10B: CBCT of surgical guide itself
Fig.10C: CBCT of apatient with surgical guide
Six implants were installed in the edentulous maxilla with the DSD Clic Guide using a flapless technique (Fig.11A, 11B, 11C). The same file obtained through the 3D Digital waxing was used to make the provisional prosthesis of this patient with the intention of installing the provisional at the end of the surgery using the concept of immediate loading (Fig. 12A, 12B, 12C). 
Fig.11A: DSD Clic Guide
Fig. 11B: DSD Clic Guide
Fig. 11C: DSD Clic Guide - Flapless technique 
Fig. 11C: DSD Clic Guide - Flapless technique 
Fig. 12A: Provisional denture installed immediately after placing the implants
Fig. 12A: Provisional denture installed immediately after placing the implants
Fig.12B: Picture taken immediately after surgery
Figure 12C: 7 Days Post-Op
The use of DSDApp and DSD concepts are useful tools to achieve a satisfactory aesthetic result even in cases of full upper denture restoration. Using the DSD Planning Center’s Clic Guide facilitated the installation of the provisional prosthesis reducing error and time.
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Special thanks to Dr. Felipe Miguel Saliba for sharing this case with us!
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Full Mouth Denture Restoration over Immediate Loading Implants