case_images: PMC10757662_01
case_images: Panoramic radiograph (OPG) image depicting the patient's residual dentition not worthy of preservation and a severe generalized horizontal bone loss of 80-90%.
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case_images: fig1
case_images: In the first step, under endotracheal tube intubation general anesthesia (ETGA), the residual dentition (Figure 1) was removed.
case_images: Panoramic radiograph (OPG) after implant placement and exposure at the time of impression taking. The correct fit of the scan bodies was ensured with an X-ray.
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case_images: PMC10757662_01_CRID2023-6681076.002.jpg
case_images: fig2
case_images: To address these challenges, four implants were placed in the lateral incisor positions in both jaws using Straumann  implants (012: 4.1 x 10 mm, 022: 3.3 x 10 mm, 032: 4.1 x 10 mm, and 042: 4.1 x 8 mm; Straumann  Group, Basel, Switzerland) (Figure 2).
case_images: Straumann  RC (3 mm) healing abutments were used to form the implant surrounding gingiva: (a) upper jaw and (b) lower jaw.
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case_images: fig3
case_images: Implants were placed as distally as possible to cover a larger span of the respective jaw (Figure 3).
case_images: CAD/CAM-milled provisional FPD made out of PMMA (PMMA-Disk, Yamahachi Dental , Gamagori, Japan) (a). An extreme short dental arch (ESDA) is depicted with an extension from canine to canine (upper jaw) and from first premolar to first premolar (lower jaw). The patient now shows an even smile line and natural visibility of the anterior teeth (b).
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case_images: PMC10757662_01_CRID2023-6681076.004.jpg
case_images: fig4
case_images: After the implants had healed and osseointegrated, an experimental fixed partial denture (FPD) made of milled PMMA (Yamahachi Dental , Gamagori, Japan) was fitted (Figure 4). The corresponding restorations were milled from PMMA and connected to titanium base abutments for screw fixation (Figure 4). A six-month provisional phase followed, during which the patient tested the new occlusal vertical dimension (OVD), occlusion, esthetics, and cleanability of the restorations (Figure 4).
case_images: Clinical images were taken at the time of impression taking and registration. Digital impression taking with an intraoral scanner was not possible due to the high mobility of the soft tissues. Scan bodies (L1410, Straumann  Group, Basel, Switzerland) were used as registration aids (a). Bite registration was performed with Beauty Pink wax (Integra Miltex, Princeton, NJ, USA) and Futar  (Kettenbach  Dental, Eschenburg, Germany) in the centric condylar position (c). Severely shortened impression trays with fixed analog impression posts (b). Honigum Putty and Light Body (DMG Dental, Hamburg, Germany) were used as impression material.
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case_images: fig5
case_images: A conventional impression using silicone (Honigum Putty and Light Body, DMG Dental, Hamburg, Germany) and an adapted rigid plastic tray was then taken (Figure 5(b)), which was associated with bleeding at the commissures and severe pain. Scan bodies (L1410, Straumann  Group, Basel, Switzerland) were used as registration aids (Figure 5(a)), as they were readily available, had sufficient height, and provided a flat surface for the wax registration plate to rest on (Figure 5(b)). The plate was then relined and fitted with silicone (Futar , Kettenbach  Dental, Eschenburg, Germany) (Figure 5(c)).
case_images: Completed FPD made out of milled and veneered metal-ceramic (Tizian Blank, Schutz Dental, Rosbach vor der Hohe, Germany) (a). Due to the restricted mouth opening, the patient appears completely dentate (b).
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case_images: PMC10757662_01_CRID2023-6681076.006.jpg
case_images: fig6
case_images: The FDPs were then screwed into the patient's mouth (Figure 6), with a torque set to 35 N cm in accordance with the manufacturer's instructions.
case_images: Panoramic radiograph (OPG) taken one year after the placement of the definitive restorations. The framework of the extremely shortened dentition (ESDA) is clearly visible, and the peri-implant bone conditions show no signs of inflammation.
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case_images: PMC10757662_01_CRID2023-6681076.007.jpg
case_images: fig7
case_images: During the recall, we conducted a panoramic radiograph (OPG) (Figure 7) and assessed both intraoral and extraoral examinations.