Mandibular immediate rehabilitation with a pre-fabricated Titanium bar

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Posted on By José Ferreira In Implants

A 66-year-old male patient with absence of most of the teeth, lack of esthetics and difficulties in chewing. After a careful intra-oral evaluation, diagnostic radiographic examinations (Orthopantomography and CBCT) ,
Trefoil surgery was performed with the placement of three implants between mental foramen with surgical guides followed by immediate loading with a prefabricated titanium bar incorporated within a definitive prosthesis at the very same day . To turn this surgery more predictable whe decided tu use a Surgical Guide for the central implant, reducing also the surgery time.



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Jose; Thank you for sharing. Well done. How do you provide Final prosthesis on day of surgery without accounting for tissue shrinkage after healing? Do you reline after a period of time? Is the prosthesis the same day? Thanks for sharing. Dr. Salama


Hi Dr.Salama and thank you for the pertinent questions.
—As we do the osteotomy, the surface of the mandibular bone becomes larger and without the teeth sockets, the bone tends to suffer a less aggressive remodulation. On the other end, as we don't cut the remaining tissue of, we keep all the keratinased tissue around the polished 4,5mm colar of the implants and the prosthesis its made to pressure the tissue as far as possible. The inicial idea was to do a reline each case after 3 to 4 months but the truth is that the remodulation that we are experiencing its not that relevant and in some cases the patient find it even useful because it turns the normal higien easier to preform.
—The idea of the technic its to go from A to Z in about 6 to 7 hours but sometimes, to avoid the waiting of the patient in the clinic (or if the try-out of the final tooth setup in wax its not good at the first time) we sometimes prefer to deliver the final prosthesis on the next morning.


Quite amazing concept, saving lots of chair time.

I would have same question as Maurice.

Also, how does it compensate for any possible implant deviation?

Very nice work


Hi Andoni, thank you so much for your words and for your great question.

—Exactly, one of the best things about this technic its the significant reduction of chair time. The surgical parte, if you don't lose any time doing fotos, films, etc, takes about 1:30h.

—In respect of the possible implant deviation, the prefabricated bar allows a 0,4mm of horizontal deviation, 0,5mm vertical deviation and a 4 degrees of angular deviation. This is, at the end, a guided surgery and like all guided surgeries there are always same minor deviations but, until now, the bar was able to compensate in all the cases we have done.

If ,any way, an implant fails, there is always the possibility of doing it later with specific surgical guides and you can, in the worst case scenario, secure the prosthesis with 2 locaters abutments temporarily.