PMC8069676_01
Preoperative anterior maxillary atrophy.
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The maxillary teeth were found to be carious with poor periodontal prognoses, and the maxillary area was partially edentulous with severe osseous atrophy (Figure 1).
Preoperative CT.
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The anterior maxillary ridge bone was 1-2-mm thick (facial/lingual) on CBCT (Figure 2).
Decortication for medullary bleeding.
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Cortical perforations were made with a No. 4 round burr for access to subjacent cancellous bone and to achieve medullary bleeding (Figure 3).
Particulate grafting with collagen membrane.
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The barrier was press-fit bone tacked into position with a nonresorbable titanium bone tac measuring 3 mm in length pins using mallets on the facial and apical aspects (Figure 4). A 15 cc BioHorizons MinerOss (Birmingham, Al.) cortico-cancellous allograft bone graft material was placed at the maxillary facial and crestal osseous aspect and extraction socket area (Figure 4).
Primary closure with suture.
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Following this, the palatal aspect of the membrane was secured, and a primary flap closure was performed using a combination of simple interrupted and continuous 3-0 black silk sutures to obtain primary closure (Figure 5).
Postoperative.
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The maxillary ridge was found to be augmented to 6-8 mm in width as compared to the 1-2 mm of original thickness (Figure 6).
CT after 4 months: (A) preoperative width, (B) postoperative change in width, (C) measurements of postoperative augmentation.
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Width was increased remarkably, which was necessary and adequate for implant placement (Figure 7).
Digital planning and post-implant placement.
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Implant placement surgery was performed 4 months after bone graft placement (Figure 8).
Hybrid prosthesis.
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After implant placement, using 5 temporary titanium sleeves, 5 multiunit abutment analogs, and 5 multiunit abutments (BioHhorizons, Birmingham, Al) (Table 2), a screw-retained fixed acrylic prosthesis was fabricated (prefabricated during previous appointments), and an attempt was made to maintain the vertical and centric relation; chair side conversion of the denture was performed with soft relining for an immediate load (Figure 9).