This partially edentulous patient presents with multiple non-salvageable teeth. The radiographs below show generalized severe periodontal disease and pneumatization of the maxillary sinuses. However, sufficient alveolar bone remains for the placement and restoration of implants in both the maxillary and mandibular arches. The treatment plan is for the restoration of the mandible with a screw-retained appliance on 6 implants. The maxilla will be restored with a removable, palateless denture on 6 implants.

After the remaining teeth are removed, mandibular implants are placed. Immediate maxillary and mandibular dentures are fabricated as provisionals.

After suitable healing of the mandibular implants and the final impression, a confirmation jig is fabricated to ensure impression accuracy.

The bar wax up is compared to an index of the mandibular denture to ensure the bar will provide sufficient support for the teeth.

At this point, suitable maxillary healing has occurred. A surgical stent provides guidance for the placement of the maxillary implants.

The final appliance.

The implant analogs attached to the appliance.

The mandibular screw-retained appliance. The maxilla will be restored after the maxillary implants have osseointegrated.