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Clinical Case Report

Conventional Loading of Four Implants in the Edentulous Maxilla and Restoration with a Bar-Supported Overdenture

Henny J.a. Meijer, Wim Slot, Gerry M Raghoebar

A 64-year-old male patient was referred to the University Medical Center Groningen, The Netherlands, for dental implant treatment. The patient had been edentulous in both the maxilla and mandible for 25 years. During these 25 years, three conventional dentures had been fabricated, the most recent one being 2 years old. The patient complained of inadequate retention and stability of his maxillary and mandibular dentures. The esthetic aspect was of medium importance to the patient. His medical history was unremarkable.

Surgical classification
Complex
Prosthodontic classification
Complex
Source
Treatment Guide 15
Purchase price
10 Academy Coins
CPD/CME
0.25 hours

Recommended content

General Risk Assessment

Patient-related Factors
Oral hygiene Good
Compliance Good
Patient-medical Factors
Medical Fitness Healthy, able to undergo planned anesthesia and surgical procedure (ASA I)
Medications No medications that would negatively affect the surgical procedure and outcomes.
Radiation Treatment None
Growth Status Complete
Site-related Factors
Access Adequate
Pathology near the implant site None
Previous surgeries in planned implant site No previous procedures.

Surgical Classification

Surgical Complexity
Timing of placement Healed (Type IV)
Simultaneous or Staged grafting procedures Implant placement as part of staged hard and/or soft tissue procedures
Number of implants > Three
Anatomy
Bone Volume - Horizontal Deficient, requiring a separate augmentation procedure prior to implant placement
Bone Volume - Vertical Moderate deficiency requiring simultaneous horizontal augmentation. Deficient, requiring a separate augmentation procedure prior to implant placement
Keratinized Tissue Sufficient (>4 mm)
Soft Tissue Quality No scars or inflammation
Proximity to vital anatomic structures Moderate risk of involvement

Prosthodontic Classification

Complicating Factors
Biological Screw-retained restorations with appropriate contours
Mechanical/Technical Absence of contributing factors
Planned contour of tissue-fitting surfaces Appropriate contours (hygienic - accessible for maintenance)
Prosthesis Factors
Prosthetic volume Adequate. Space available for ideal anatomy of the restoration
Inter-occlusal space Adequate. Capable to create an anatomically & functionally correct planned restoration
Occlusal Factors
Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involvement
Occlusal parafunction Absent
Complexity
Loading Protocol Early/Conventional
Interim prosthesis Tissue or interim implant supported
Number of implants >2 (non-splinted) or ≥ 2 (splinted)
Timing of placement Healed (Type IV)

Esthetic Risk Assessment

Edentulous Esthetic Risk Assessment (removable)
Facial Support Desired tooth position provides sastifactory labial support
Labial Support Flange provides required lip support
Upper Lip Length Long upper lip (>20mm)
Buccal Corridor Narrow corridor
Smile Line No display of the Maxillary ridge at full smile
Maxillomandibular Relationship Class I
Publication date: Dec 3, 2025 Last review date: Nov 26, 2025 Next review date: Nov 26, 2028

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