PMC7695486_01
Baseline: (a-c) clinical situation of the patient at the baseline. (d) Radiological situation at the baseline.
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Extraoral examination revealed a VME reflected by an excessive gingival display at smiling, showing unpleasantly the whole maxillary process all the way up to the tuberosities (Figure 1).
Left hemimaxilla: (a, b) segmental osteotomy of the alveolar process. (c) Lateral window approach during left maxillary sinus floor elevation. (d) Crushed resected alveolar process grafted inside the sinus. (e) Picture showing lateral bony window placed back and implant inserted in the canine region. (f-h) Respectively: frontal, lateral, and occlusal view of the postoperative clinical situation immediately after suturing.
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Then, the buccal flap was repositioned apically to preserve the keratinized mucosa (Figure 2).
Right hemimaxilla: (a, b) clinical situation 2 weeks following left hemimaxilla resection and immediately before proceeding with the right hemimaxilla. (c) Segmental osteotomy of the right hemimaxilla. (d) Impacted canine extraction. (e) Implant insertion in the remaining canine socket. (f) Jumping space filled with autogenous resected alveolar process. (g) Sinus floor elevation. (h) Occlusal view of the postoperative clinical situation.
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The right maxillary subantral space was packed first with bovine xenograft (Ti-Oss, Gyeonggi-do, South Korea) towards the back and then filled with the remaining autogenous resected ridge anteriorly (Figure 3).
Temporization, 2-3 weeks following right hemimaxilla segmental resection: (a) maximum smile showing the successfully eliminated gingival display. (b) Occlusal view of the healed maxilla with two protruding implant overdenture attachments. (c) Respective housings mounted over the overdenture attachments to be picked-up in the denture intrados by a relining procedure. (d) Denture ready to be seated over the attachments. (e) Patient new smile with the retained denture in the mouth.
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Following sinus graft maturation: (a) Panoramic x-ray 6 months following segmental osteotomy along bilateral sinus augmentation. (b) Panoramic x-ray, 8-months following segmental osteotomy along with bilateral sinus augmentation, and 2 months after implant placement in the sinuses region. (c, d) Two implant placement per each sinus 6-months following bilateral sinus floor elevation. (e) Occlusal view of the maxilla immediately after implant placement and flaps suturing.
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Final rehabilitation of the maxilla: (a, b) Pictures of the impression copings over their respective implants. (c) Passivity fit check using a milled bar. (d) Occlusal view of the maxilla with abutments off. (e) Occlusal view of the maxilla showing five straight multiunit abutments mounted over their respective implants. (f) Try-in of the final milled mesostructure. (g, h) Try-in of the mesostructure after it was layered with pink ceramic. (i, j) Try-in of the individual crowns over the mesostructure. (k, l) Maxillary work completed.
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The said prosthesis was screwed-in safely directly over one implant and indirectly through the 5 underlying multiunit abutments, and the individuals crowns cemented on its top subsequently (Figure 6).
Mandible: (a) Baseline situation of the left hemimandible. (b) Three implants insertion in position #34, #36, and #37. (c) Autogenous bone block harvesting from the external oblique line. (d) Harvested block split in two. (e) Bone block fixation in the recipient site. (f) Autogenous bony particulates filled in the medullary zone. (g) Coverage of the augmentation area by a membrane. (h) Situation at uncovery, 2 months after the augmentation procedure. (i) Abutments and prepared teeth ready to receive their crowns. (j) Mandibular work completed showing the bridges in place.
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Tissues, Nantes, France). Two months later, implants on both sides were restored prosthetically, with porcelain fused to metal crowns taking into consideration an adequate vertical dimension. The anterior teeth underwent a root canal treatment and received 6 splinted zirconia crowns (Figure 7).