12-Unit Titanium Framework Provides Strength, Needed Support

This was one of my most noteworthy cases of the year due to the size of the metal substructure.

The patient was unhappy with the fit and esthetics of her existing denture. The dental team decided to place four zygomatic implants; during the surgery, the surgeon also removed a large amount of bone and some failing implants to level the horizontal plane. I fabricated a new immediate denture for the surgery appointment and converted it for an immediate load.

I designed the framework using 3Shape software, milled a PMMA bar on a Roland mill and tried it in the mouth. After some design modifications, I outsourced the final framework so it could be milled in titanium.

We chose a titanium framework because it’s light but won’t fracture, gives the zygomatic implants a very rigid support, can be easily trimmed to correct the walls of the preps and make small modifications, and readily accepts the composite veneering and crown cementation after treating the surface.

Once...