CAMLOG Special Issue 2011

Case Report 13 | 2011 Fig. 8: Full-thickness flap preparation, demonstrating the dimension of the alveolar bone crest. Note the dif- ference in bone width between the left side (extrac- tion only) and the right side (ridge preservation). Ridge preservation seems to be a suitable technique to enhance the hard-tissue situation. Fig. 9: I nsertion of four implants (3.8mmx 13mm). The patient, a 61-year-old female, had lost her upper and lower molars due to a traffic accident two years prior to the initial visit in our practice. Tita- nium plates had been placed in the lower molar region on both sides and she had worn a partial denture. She had been using only her anterior teeth to bite and experienced nerve paralysis even two years after the accident. Due to her unstable occlusal condition, her anterior teeth were severely mo- bile at the time of the initial visit, and she hoped to get these teeth extracted. In a full-mouth implant reconstruction case like this, the value of the result should be judged with regard to the long-term prognosis. This case has been treated for 8 years, now: 6-year treatment since the first visit and 2-year Information about patient and treatment Fig. 7: Clinical situation after 6 months: nicely healed soft- tissue contour of the alveolar ridge. The right side seems to demonstrate a wider dimension of the al- veolar crest. Implant insertion in the maxilla recall maintenance. All of the remaining teeth in the maxilla were extracted, and the socket preservation was implemented. Then, the surgical guide was fixed on the four implants placed in the anterior area as anchors, and four implants were placed in the maxillary tuberosity and sinus septa areas. In the mandible, the posterior teeth were neuroparalysed due to the effect of the accident, and the anterior teeth were displaced lingually. The displace- ment was corrected by an orthodontic treatment using the posterior im- plants as orthodontic anchors, and the occlusion was recovered. The neuro- paralysis has been relieved progressively, and the patient is satisfied with the treatment and the results. This is a comprehensive case comprising sur- gical, prosthetic and orthodontic procedures. Fig. 1: Clinical situation: The occlusion had collapsed as a result of the traffic accident. Fig. 2: Only the upper and lower anterior teeth were incor- porated or involved in functional occlusion. Initial presentation Fig. 4: R adiographic situation. Titanium plates had been in- serted in the posterior regions of the mandible. Fig. 5: The maxillary teeth were carefully extracted. Fig. 6: After extraction, on the right side, ridge preservation technique was applied to preserve the soft- and hard- tissue contours: The alveolar sockets were filled with Bio-Oss ® and coveredwithBio-Gide ® membranes. The extraction sockets on the left side were left untreated. Fig. 3: T he upper anterior teeth were mobile and hopeless. They were extracted. Tooth Extraction