tall and tilted pin hole immediate loading

surgical guide for tall and tilted pin hole immediate loading all TILT PROTOCOL

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2. Guided Full Mouth Implant Rehabilitation in Atrophic Alveolar Ridges Using TTPHIL ALL TILT® Protocol: A Case Report With Three Years Follow-Up Presented By : Dr. GURUNATH Nag V, Roy M, Ramanathan M. Guided Full Mouth Implant Rehabilitation in Atrophic Alveolar Ridges Using TTPHIL ALL TILT® Protocol: A Case Report With Three Years Follow-Up. Cureus . 2023 Oct. 2

3. Dental implants- widely accepted and scientifically validated treatment option for patients with complete or partial edentulism . Conventional implantology pose Challenges : Prolonged healing Multiple appointments Delayed loading Anatomical limitations . INTRODUCTION 3

4. 2 TTPHIL ALL TILT® Technique 4

5. This case report demonstrates the workflow and successful rehabilitation of an edentulous atrophic ridge using the TTPHIL ALL TILT® technique in combination with guided surgery. 5

6. CASE PRESENTATION 5 Diagnosis and treatment planning 6 75-year-old female Edentulous for over 20 years Medical history: on anticoagulants and thyroxin for 5 years Patient Profile: Missing teeth in both upper and lower jaw Desire to replace current dentures with a fixed prosthesis for improved esthetics and speech Chief Complaint: ASA type 3 No extensive surgical procedures due to associated morbidity Medical Considerations:

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8. Pre-operative Orthopantomogram 8

9. Fabrication Of Stereolithographic Models And Surgical Guides 9

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11. Maxillary surgical guide 11

12. Mandibular surgical guide 12

13. Surgical phase 13

14. Maxilla(upper jaw surgery) Implant placement: FIRST IMPLANT- 3.75 x 11.5 mm implant placed with 60 Ncm torque . Second implant osteotomy in the canine region, 3.75 x 16 mm implant placed . Third implant in the pterygoid region, 3.75 x 16 mm, directed superiorly, distally, and palatally 14

15. Contralateral side : Same guided implant placement technique followed. Multi-unit abutments : Canine: 15 degrees . Second premolar: 30 degrees . Second molar pterygoid region: 45 degrees . Handles parallel to each other to compensate for implant angulation 15

16. A stereolithographic surgical guide was used, and the same drilling method as in the maxilla was applied. Mandible(lower jaw surgery) 16

17. All implants torqued to 60 Ncm . Multi-unit abutments placed for: - Canine ( 20 degrees ). - Second premolar ( 30 degrees ). - Second molar pterygoid region ( 50 degrees ). The same sequence was repeated on the contralateral side. 17

18. Prosthetic phase 18

19. 19 Jaw relation record

20. 20 Implant supported provisional fixed dental prosthesis

21. Orthopantomogram of the patient after provisional prosthesis placement 21

22. Digital Impressions with Intra-Oral Scanner and Scan Bodies : Holes of scan bodies sealed; putty and light body dual impressions made.. Scan bodies attached to multi-units for digital impressions 22

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24. Try-in of metal framework 24

25. Final implant supported screw retained fixed dental prosthesis 25

26. OPG of the patient after prosthesis placement 26

27. OPG of patient at three-year follow-up 27

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31. Rehabilitation of the atrophic ridge, a commonly challenging situation for implant clinicians, was successfully completed, confirmed by the patient's three-year follow-up. The fabrication of a surgical guide, an immediate provisional fixed dental prosthesis, the final CAD/CAM framework reconstruction has fulfilling the patient’s wish for immediate function in a minimally invasive manner using the TTPHIL-ALL-TILT® protocol. 31

32. CRITICAL APPRAISAL No Preoperative Intraoral Photographs Were Shared. . Limited literature available on the TTPHIL ALL TILT® technique case report likely focuses on one or a few patients, which limits its generalisability . 32

33. CROSS REFERENCES 33

34. Nag PV, Dhara V, Puppala S, Bhagwatkar T. Treatment of the complete edentulous atrophic maxilla: the tall tilted pin hole placement immediate loading (TTPHIL)-ALL TILT™ implant option. J Contemp Dent Pract . 2019 Jul 1;20(6):754-63. An anatomically driven, graftless solution, addresses these challenges by eliminating cantilever forces, ensuring minimal invasiveness, and providing screw-retained prosthetic solutions with immediate cross-arch stabilization . 34

35. 27 PUPPALA VR, PuPPala S, Daniel S. The Use of Computer Guided Tall and Tilted Pin Hole Immediately Loaded Implants (TTPHIL) Technique for Severe Atrophic Maxilla Rehabilitation: A One Year Follow-Up. Journal of Clinical & Diagnostic Research. 2021 May 1;15(5). The technique presented for maxillary rehabilitation eliminated the need for a cantilever by using a graftless , guided, single osteotomy approach with six tilted implants and 14 teeth. This method improved clinical ease, patient acceptance, and chewing efficiency in a single appointment . 35

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