Rehabilitation of extremely atrophic edentulous mandible in elderly patients with associated comorbidities: a case report and proof of concept

BACKGROUND: Oral rehabilitation of the atrophic mandible is, most of the time, a challenging procedure, especially in elderly patients with associated comorbidities. CASE PRESENTATION: This clinical report describes the rehabilitation of an extremely atrophic mandible using an overdenture supported by four splinted implants, two of which are placed in the interforaminal region and the other two bypassing the inferior alveolar nerve at the level of the antegonial notch. A passive-fit bar structure splinting the four inserted implants was designed to compensate for mandibular flexure, to reduce the amount of strain on the implants, and avoid bone resorption and prosthetic failure. The 14-month postoperative cone-beam computed tomography (CBCT) and the clinical follow-up showed the bilateral integrity of the inferior alveolar nerve and the successful restoration of the atrophic edentulous mandible with a significant improvement in the patient’s quality of life. CONCLUSIONS: The applied technique depicts several benefits such as a minimally invasive approach, reduced number of surgical interventions, reduced total treatment time, reduced treatment costs, and higher psychological acceptability.