Custom Multi-Unit Implant Abutments Best Option for Patient's Extreme Implant Angles

The patient presented with an edentulous upper arch and wanted a fixed, implant-supported restoration. Due to inadequate bone, the ideal solution would have been a double sinus lift to accommodate All-on-X implants; however, due to her medical conditions, budget and the required healing time, she didn’t want the surgery.

Because of the extreme angles the implants would require, stock Multi-Unit Abutments (MUA) were not an option. Per my recommendation, we decided to use custom MUAs—since they could be digitally designed to correct the path of insertion, provide tissue-level height and allow the implants to be placed in any orientation to get stable bone and avoid the sinuses—and then restore with a fixed, full-arch zirconia restoration with stock MUA Ti-bases from TruAbutment.

We took PVS impressions along with a pick-up impression of the existing maxillary denture so we could reference it while designing the positions of the screw access holes. Once the...