PMC4302971_01
Pre-treatment periapical radiographs.
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Pre-treatment smile photograph.
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Smile analysis revealed that the patient had an average smile line and maxillary incisal edges did not follow the curvature of the lower lip (Figure 2).
Schematic showing the steps of staged approach treatment plan.
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The case was treatment-planned to be staged using selected maxillary teeth # 6, 11, and 13 and the mandibular teeth # 20, 22, 27, and 29 to be retained as abutments for a fixed temporary prosthesis with a transitional removable prosthesis (Figure 3).
(a) Tenting screw technology for implant # 5 site development. (b) Significant bone increase in vertical and horizontal dimensions, confirmed by the CBCT sagittal slice.
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Tooth # 5 was selected for extraction and GBR with tenting screw technology as part of the maxillary grafting procedures (Figure 4).
Steps of phase I treatment. (a) First set of provisional prostheses delivered after planned teeth extraction. (b) Intraoral picture 1 month after planned teeth extraction. (c) Intraoral picture depicting delivery of enhanced provisional prostheses.
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Abutment teeth # 20, 22, 27, and 29 were used to retain a mandibular fixed provisional prosthesis (Figure 5).
Internal sinus lift and implant osteotomy prepared through the surgical guide for site # 14.
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Panoramic radiograph shows the placement of six implants per arch. Note metal-reinforced fixed provisional prostheses retained by retained teeth.
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The provisional pontic areas above the implants were relieved slightly to allow for minor swelling (Figure 7).
Soft tissue enhancement around lower molar implants, during stage 2 implant uncovery.
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After 3 months, all the implants were uncovered and periodontal plastic surgery, with partial thickness flaps, 2 vertical releasing incisions, and an apically positioned flap, was performed for site 3 and the mandibular molar areas due to lack of attached gingiva (Figure 8).
Intraoral photograph shows screw-retained implant provisional prostheses. Pink acrylic was added to enhance esthetics, which will be used as "blue-print" for the definitive prostheses.
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The screw-retained provisional prostheses were delivered at this point (Figure 9).
Flapless immediate one-stage implant placement at # 6 and # 11 extraction sockets.
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The sites were stabilized with Vicryl 4-0 sutures after easy removal of the mucosal-tooth-borne guide (Figure 10).
Photographs show patient's smile. (a) Pre-treatment. (b) During treatment.
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The provisional fixed prostheses were finished and polished around newly added temporary cylinders and delivered back to the patient (Figures 11 and 12).
Frontal views for patient's smile. (a) Pre-treatment. (b) During treatment.
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The provisional fixed prostheses were finished and polished around newly added temporary cylinders and delivered back to the patient (Figures 11 and 12).