A 34-year-old male patient involved in a road traffic accident sustained a parasymphyseal mandibular fracture with avulsion of 7 teeth and extensive soft tissue injury. Following maxillofacial surgical repair and 9 months of healing, a full prosthodontic rehabilitation was completed using 6 mandibular implants and an implant-retained hybrid prosthesis in the lower arch, combined with fixed ceramic restorations in the upper arch.
Clinical Findings
Post-traumatic mandibular reconstruction with titanium plates (parasymphyseal fracture, repaired acutely). Avulsed: LL1, LL2, LL3, LR1, LR2, LR3, LR4. Retained mandibular teeth: LL5, LL6, LL7, LR5, LR6, LR7. Upper arch: UR1 fractured (Ellis III), UL1 subluxed and endodontically treated, UL2 avulsed (replaced with immediate PMMA shell). Remaining upper teeth structurally sound. Healed mandibular ridge — CBCT confirms 7–10 mm bone width at symphysis (previously augmented with block graft by OMFS), 12 mm at premolar regions. Soft tissue: healed with minor scar contracture at lower lip.
Occlusal Analysis
No occlusion in anterior region due to missing lower anterior teeth — posterior contact only on both sides. Lower posterior teeth slightly extruded (9 months without opposing contact). Upper arch: mild crowding, all teeth present except UL2. Centric relation stable — condyles well-seated. VDO appears maintained by posterior contacts.
Comprehensive interdisciplinary planning involving prosthodontics, oral surgery review, and implant planning.
Procedures
Patient regained full dental function and natural aesthetics within 14 months of starting prosthodontic phase. Mandibular hybrid prosthesis screw-retained — no complications at 2-year review. All upper zirconia crowns intact. Patient returned to professional career and reports 100% quality-of-life restoration post-trauma.
Annual removal and servicing of hybrid prosthesis (torque check, PMMA inspection, cleaning). 6-monthly hygienist visits with specialised implant cleaning protocol. Upper zirconia crowns: annual clinical review. Patient uses oral irrigator (Waterpik) and interdental brushes daily.
2-year review: 6 mandibular implants all stable (ISQ 75–84). Upper zirconia crowns intact. Hybrid prosthesis removed for annual servicing — all screws torqued and acrylic checked. Minimal wear on PMMA teeth — replacement planned at 5 years. Patient maintains excellent oral hygiene with interdental brushes and oral irrigator.
Nice work on the soft tissue management. Often overlooked but makes such a difference.
Wonderful case. Would love to see a 1-year follow-up.
Impressive result! Did you use any digital workflow here?
The radiographic follow-up would be great to see here.
Beautiful aesthetics. The shade matching is perfect.
How did you handle the occlusal scheme post-treatment?
Wonderful case. Would love to see a 1-year follow-up.
Great documentation — always inspiring to see the full workflow.
The pre-op planning clearly paid off. Excellent outcome.
Love the before/after comparison. What materials did you use for the final restoration?
good job
Sign in as a dentist or clinic to like, save, and comment.
Patient Privacy
All cases are shared with patient consent. No personally identifiable information is included.
Notes
Titanium fixation plates from initial OMFS repair required careful mapping during implant planning — 2 planned implant positions adjusted by 1.5 mm to avoid plate interference. Final plan confirmed with OMFS — no plate removal required. Patient education intensive at this stage — hybrid prosthesis maintenance, hygiene, and realistic expectations discussed.
Placement of 6 Straumann BLX implants in the mandibular anterior/premolar region under guided protocol.
Procedures
Notes
Excellent primary stability achieved — all implants eligible for immediate loading. Implant at LL1 site had 8 mm bone width — adequate without additional grafting despite prior trauma. Post-op CBCT confirmed 2 mm clearance between nearest implant and titanium fixation plate. Patient woke from sedation with provisional teeth in place — emotional moment for patient and team.
Concurrent management of upper arch restorations while awaiting mandibular osseointegration.
Procedures
Notes
Managing upper arch in parallel with mandibular healing allowed efficient use of the 3-month osseointegration period. Patient received a significant aesthetic improvement to upper arch even before lower arch was finalised. UL2 space managed with provisional pontic on PMMA bridge — incorporated into final zirconia bridge.
Fabrication and delivery of the definitive implant-retained hybrid prosthesis — milled titanium framework with PMMA denture teeth.
Procedures
Notes
Passive fit verification was critical given the extended span across the mandibular arch. Sheffield test confirmed zero rocking before seating. Bilateral balanced occlusion chosen for this full arch case — gives maximum stability and load distribution across all 6 implants. Patient was overwhelmed with emotion at delivery — first time with fixed teeth since accident.
Delivery of definitive upper arch zirconia restorations to complete the full rehabilitation.
Procedures
Notes
Shade matching challenging due to adjacent soft tissue colour change from scar. Digital shade guide (Vita Easyshade V) used with manual cross-check under standardised LED lighting. Three-unit bridge at UL1–UL3 incorporates UL2 pontic — ovate pontic design for natural emergence profile.
