PMC3377904_01
Above: Initial panoramic and clinical views of occlusion and tooth alignment. Below: Periapical radiographs of the maxillary incisors.
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The patient was especially concerned about all four maxillary incisors (Fig. 1). Radiographic evaluations revealed moderate to severe generalized bone loss (Fig.1). The crown/root ratio of the central incisors was about 2/1, which explained the severe mobility (Fig. 1c). In agreement with the patient's wishes, and taking into consideration the crown/root ratio of the canines and premolars and the extent of the future edentulous area (Fig. 1b), the decision was made to place implants.
Tomographic scans of the maxillary incisors before treatment (top row) and after treatment (bottom row). Left to right: right lateral incisor, right central incisor, left central incisor, left lateral incisor.
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These distances ranged between 12.8 and 15.7 mm for the maxillary incisors (Fig. 2). The amount of bone that had been regenerated in the incisor area ranged between 2 and 3.9 mm (Fig. 2).
Forced eruption was initiated.
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Edgewise brackets were bonded to the surfaces of all maxillary teeth between and including the first molars (Fig. 3).
After extraction, the central incisor sockets were filled with Bio-Oss up to the level of the alveolar crest.
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The sockets of the central incisors were filled with bone grafting material (Bio-Oss) up to the level of the crestal bone (Fig. 4). 
Left: The remodeled extracted teeth were attached to a previously fabricated removable acrylic resin partial denture in their original positions. Right: Provisional denture in use.
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The reshaped extracted teeth were attached to a previously fabricated removable acrylic resin partial denture in their original positions (Fig. 5a), and the denture was delivered to the patient about 3 hours after extraction of the teeth. This continuity of use was essential to maintain soft tissue form (Fig. 5b). 
View of the sockets at 5 weeks after extraction.
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One month after extraction of the teeth, epithelialization of the socket surfaces was complete (Fig. 6a). For this reason and to evaluate the bone volume after extraction of the teeth and determine the ideal paths of implants, a template was made using transparent acrylic resin (Fig. 6b). The outcome of the reshaping thus accurately represented the patient's residual bone (Fig. 6c). After a cone beam computed tomogram was obtained with the template in place, the final paths of the implants were corrected on the template (Fig. 6d). 
Bone mapping using an acrylic resin template.
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The definitive prosthesis was delivered to the patient after 4 months (Fig. 7).