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Clinical Case Report

Immediate Loading of Four Narrow-Diameter One-Piece Implants in the Edentulous Mandible

Clemens Raabe, Nicole Schenk, Martin Schimmel

A 63-year-old female patient presented at the School of Dental Medicine of the University of Bern, Switzerland (zmk Bern) with the goal of improving her dental appearance and finding relief from the persistent pain and discomfort in her teeth and gums. While recognizing the need for surgical interventions, she aimed to minimize the number of surgeries required. The patient suffered from obesity and mild hypertension, treated with amlodipine and valsartan under the care of her physician. She lived independently and appeared to be active and cognitively fit. Financial limitations for dental treatment were present.

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

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General Risk Assessment

Patient-related Factors
Oral hygiene Poor
Compliance Adequate
Patient-medical Factors
Medical Fitness Moderately compromised health, but can undergo planned anesthesia and surgical procedure (ASA II to ASA III)
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 without adjunctive procedures
Number of implants > Three
Anatomy
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 Compromised. Can be resolved without adjunctive therapy
Occlusal Factors
Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involvement
Occlusal parafunction Absent
Complexity
Loading Protocol Immediate
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
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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