I have acquired a new patient by the suggestion of his oral surgeon, for the restoration and recovery of his maxillary arch which was restored as an All-on-4 case.

This 73 year old male received an AO4 prosthesis opposing his natural dentition from 18-31(with moderate horizontal bone loss) approximately 2 years prior to experiencing complications. During this time it does not sound as if the prosthesis was ever removed for maintenance and his dentist moved out of the state. He presented back to the oral surgeon after experiencing pain. His complication was a fractured implant fixture in the right posterior implant position (site 4). This implant was removing and replaced along with another implant in site 3 as well. During this time, he loosely saw the general dentist who purchased the old practice, yet had a new provisional prosthesis fabricated by a lab at the surgeons office. At one follow up visit, there were further complications: the provisional metal sleeve inside of the prosthesis that seated on the implant in site 7 had now fractured, as well as the prosthetic screw in the left posterior most implant (site 13). These fractures were replace at the surgeon's office with the lab again. This is when I had the pleasure of meeting him, along with the acrylic tooth #10 de-bonded from the prosthesis. I repaired this as well as fabricated an occlusal guard. The new implants are now integrated, yet it was determined that the screw in site 13 had fracture again. The suggestion from the surgeon and his lab was to restore him with a Procera Zr prosthesis.

So my question is to debate many issues about this case before it is actually embarked on further.

- Do I have another implant placed in the left posterior area approximately site 14. The surgeon already informed me there is adequate bone in this area.

-Would a Zr prosthesis be a benefit or further detriment? He has proved to fracture more metal components (2 screws, 1 provisional sleeve and 1 implant fixture) than acrylic teeth (de-bonded 10 once).

I look forward to hearing your replys.