{"id":10471,"date":"2020-11-09T07:41:53","date_gmt":"2020-11-09T06:41:53","guid":{"rendered":"https:\/\/botiss.com\/product\/implant-supported-rehabilitation-of-the-maxillary-ridge-integration-of-surgical-periodontal-and-prosthetic-concepts\/"},"modified":"2023-08-14T23:13:45","modified_gmt":"2023-08-14T21:13:45","slug":"implant-supported-rehabilitation-of-the-maxillary-ridge-integration-of-surgical-periodontal-and-prosthetic-concepts","status":"publish","type":"product","link":"https:\/\/botiss.com\/it\/prodotto\/implant-supported-rehabilitation-of-the-maxillary-ridge-integration-of-surgical-periodontal-and-prosthetic-concepts\/","title":{"rendered":"Implant-supported rehabilitation of the maxillary ridge: Integration of surgical, periodontal and prosthetic concepts"},"content":{"rendered":"

Xurxo \u00c1lvarez Lourido DDS.
\nDental technician Emilio Lopez Prado<\/span><\/p>\n

INITIAL SITUATION<\/strong><\/h4>\n<\/div><\/div><\/div>

This case report describes the rehabilitation of the maxillary ridge, combining bone regeneration techniques and periodontal plastic surgery, together with novel techniques for the management of provisional prostheses, with the goal to return the patient a harmonious pink aesthetic outcome (F\u00fcrhauser et al. 2005).<\/strong><\/p>\n

A 56-year-old patient, with good general health conditions, showed up with edentulous posterior sectors and was concerned about teeth mobility in the anterior sector as well as a bad aesthetic appearance. On clinical examination, the patient presented with advanced periodontal disease at teeth 12, 22, 11 and 21 with grade 3 mobility, thus having a poor prognosis. In a first aesthetic analysis, type 3 gingival recessions (Miller 1985) with loss of papillae and imbalance of gingival margins were observed (Fig. 1). The patient expressed her wish for aesthetic, fixed teeth and a long-term stable situation. Thus, based on the present clinical situation, it was decided to perform a rehabilitation of the complete upper jaw with an implant-supported restoration.<\/p>\n<\/div><\/div><\/div>

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TREATMENT PLANNING<\/strong><\/h4>\n

At first, a basic periodontal phase was performed to eradicate all inflammatory conditions. As teeth 12, 22, 11 and 21 were no candidates for periodontal surgery, because of the severe periodontal hard and soft tissue loss, it was decided to extract them. For the chosen approach of the full arch reconstruction and for prosthetic reasons teeth 13 and 23 were also removed.<\/p>\n

Next, an aesthetic analysis was performed, designing the ideal final restoration guided by the vertical dimension and position of the gingival margin of tooth 13. We decided to orient towards the position of the gingival margin of tooth 13 since it was the ideal one in terms bone height (Fig. 2).
\nIn the CT scan a deficiency in the alveolar bone height, which hindered the placement of dental implants, was observed. Thus, bilateral sinus augmentation was planned. In the anterior area, after the treatment of a nasopalatine cyst, bone availability was checked and considered favorable for implant placement, presenting socket type I (Elian et al. 2007) (Fig. 3 and 4).
\nIn the maxillary anterior sector, the most coronal position of the vestibular cortex was far from the ideal position of the gingival margin of the final restoration. For this reason, a vertical increase in the ridge was planned by using a connective tissue graft in a modified tunnel (Zuhr et al. 2007).
\nIn the anterior area, a submerged root technique (Salama et al. 2007) for teeth 13 and 23 was planned. With this approach, a stable periodontium to keep the canine eminences, the vestibular cortex and the level of the interproximal bone crest can be achieved. It favors the future papillae maturation based on the concepts described by Tarnow (1992), i.e. predictability of the papilla based on the distance from the interproximal bone crest to the point of contact.
\nImplant distribution was considered another critical factor. It was decided based on functional and aesthetic factors to use contiguous implants at position 11 and 21. At this site, for the most critical papilla (Tarnow et al. 1992) to achieve an ideal location, there is no possibility of a symmetric comparison.
\nThe implants placed in position 14 and 24 adjacent to submerged roots will ensure a good level of interproximal bone, preserved by the periodontium of the roots of teeth 13 and 23 (Salama et al. 2007).<\/p>\n

A wide area of \u200b\u200bpontics in the anterior sector will be left in order to be able to handle the papillae in a predictable and symmetrical way (Tarnow et al. 1992). A flapless surgery was anticipated to maintain vascularization from the periosteum and thus, to minimize bone resorption (Blanco et al. 2008).
\nA provisional prosthesis was selected according the criteria of critical and subcritical contour (Oscar Gonzalez et al. 2010). The emergency profiles were transferred individually to the laboratory to achieve the final restoration.<\/p>\n<\/div>\n<\/div>\n<\/div>

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SURGICAL PROCEDURE AND PROSTHESIS<\/strong><\/h4>\n