Full-mouth rehabilitation, a new immediate loading technique: Case report.

OBJECTIVE: Today, there is evidence that, under certain conditions,  early (within 3 weeks days after surgery) and immediately (within 3 days after surgery) loaded implants have survival rates similar to delayed loaded implants. The aim of the present study is to describe an innovative clinical and technical procedure to achieve immediate loading with a complete mandibular and maxillar fixed bridge; we tested 2 different kind of abutments in the same arch to verify clinical ease of use and reliability. CASE PRESENTATION: 75 year old man, RPDs wearer. After full-mouth disinfection, in the first surgical stage the mandible was treated extracting the remaining teeth and roots. It was raised a full-thickness flap, the bone surface has been regularised, 6 implants inter-foramina were placed immediately after tooth and root extraction. 2 innovative abutments (OT Equator Profile, Rhein83, Bologna, Italy) were screwed to two implants and 4 Multi Unit Abutments (Nobel Biocare, Zürich-Flughafen, Switzerland) screwed to the others. Implant position was immediately transferred with the direct transfer technique and sterile silicone impression material (Elite Implant Medium, Zhermack S.p.a., Badia Polesine, Italy) which provides accurate implant position reproduction. A provisional prosthesis was relined directly after the suture stage, linking the provisional abutments, then refined and delivered within 6 hours. 
n a second surgical stage 8 implants were placed in the maxilla and 8 Equator Profile abutments were used. The same clinical and technical protocol used to rehabilitate the mandible was adopted. Periapical radiographs were taken immediately after implant placement, at the prosthetic phase, and at 1-year follow-up. RESULTS : In this case report the technique used to provide in few hours an immediate screw-retained fixed prosthesis allowed us to obtain satisfactory results with less effort and major ease of use than conventional procedure. After 3 years of function we had no loss of implants or prothetic problems. Patient satisfaction has improved using this protocol, probably due to the changeover from a removable to a fixed prosthesis. CONCLUSIONS: This type of implant-supported fixed prosthesis confirms its efficiency in the immediate rehabilitation of edentulous jaws. Besides less discomfort for the patient, a gain of time and a reduction in post-operative care, immediate loading has a remarkable, positive psychological impact on the patient. This technique, in the light of recent literature and evaluating ease of use and patient satisfaction, seems to be reliable in managing even complex implant cases.