Back to Lectures and cases

Immediate Loading of a 4 Unit Bridge in the Anterior Mandible on Implants with Low ISQ Values by Means of Intra-Orally Welded Technique

Clinical case by Dr. Degidi Marco, DDS and Daprile Giuseppe, DMD


Degidi Marco, DDS Private Practice, Bologna, Italy Daprile Giuseppe, DMD Private Practice, Bologna, Italy


Female, 61 years old, healthy. Periodontally hopeless lower incisors in an otherwise well- controlled periodontal status.

Treatment planning

Extraction of the 4 lower incisors and simultaneous placement of two Ankylos implants for immediate loading of a 4 unit bridge (Fig.1)

Figure 1


A Standard A definitive abutment is connected to each implant immediately after insertion (Fig. 2); a second abutment with conical joining is connected to the first . The RFA measurement is performed by means of a customized peg connected directly to the second abutment (Fig. 3).

Figure 2

Figure 3


Even in the presence of a clinically acceptable primary stability, RFA measurements with the costumized peg reveal low ISQ values (50 and 55 respectively). The stability can not be considered sufficient to proceed safely with immediate loading.


The second abutments are joined together by means of an intra-orally welded titanium bar (Fig. 4). The structure obtained is easily removable and, once incorporated into the prosthesis, increases its resistance to fractures, reducing at the same time implant micromovements. A second RFA measurement (Fig. 5) shows a dramatic increase of ISQ values (72 and 78 respectively). The procedure can be concluded as planned with great patient satisfaction (Fig. 6). An examination after 6 months shows perfect integration of the implants and stable ISQ values (73 and 77 respectively).

Figure 4

Figure 5

Figure 6

Sign up to our newsletter to receive more clinical cases and videos