PMC6031211_01
(a) Initial panoramic radiograph. (b) Clinical view of the anterior teeth. The roots are subgingivally and peripherally decayed.
CRID2018-9014372.003.jpg
PMC6031211_01_CRID2018-9014372.003.jpg
fig3
The initial approach was conservative aiming to keep the upper front by means of composite fillings (Figures 3(a) and 3(b)).
(a) Panoramic X-ray. (b) 3D slices showing the implant planning. The root caries can be seen.
CRID2018-9014372.004.jpg
PMC6031211_01_CRID2018-9014372.004.jpg
fig4
The patient preferred not to involve these restorations in the present anterior treatment and limited it to place only two implants in the lateral incisors' positions (Figure 4).
Stage one: implants placed with SST in the lateral incisors' sites and the immediate temporary bridge on the abutment teeth.
CRID2018-9014372.005.jpg
PMC6031211_01_CRID2018-9014372.005.jpg
fig5
Finally, a temporary acrylic bridge was cemented onto the four abutment teeth 13-11 and 21-23 (Figure 5).
Stage two: partial extraction of the remaining teeth and placement of the second provisional onto the uncovered implants.
CRID2018-9014372.006.jpg
PMC6031211_01_CRID2018-9014372.006.jpg
fig6
The first provisional cemented onto the teeth was then replaced by a second acrylic bridge screwed onto the implants though temporary abutments (Figure 6).
Frontal view of immediate provisional after implant placement, 3 months after healing and 1 month after 2nd implant provisional prosthesis. Soft tissue view before prosthodontic phase.
CRID2018-9014372.007.jpg
PMC6031211_01_CRID2018-9014372.007.jpg
fig7
Little if any differences in the buccal tissue volume and no noticeable aesthetic impact could be found after the multiple extractions (Figure 7).
Final restoration in place and its integration on the patient smile.
CRID2018-9014372.008.jpg
PMC6031211_01_CRID2018-9014372.008.jpg
fig8
The final clinical aspect can be appreciated in the pictures (Figures 8 and 9).
Aesthetic appearance after 6-month follow-up.
CRID2018-9014372.009.jpg
PMC6031211_01_CRID2018-9014372.009.jpg
fig9
The final clinical aspect can be appreciated in the pictures (Figures 8 and 9).