case_images: PMC11756935_01
case_images: Soft tissue proliferation and exposed reconstruction plate.
case_images: CRID2025-7502566.001.jpg
case_images: PMC11756935_01_CRID2025-7502566.001.jpg
case_images: fig1
case_images: On intraoral clinical examination, there were six implants (13 and 23 [area 4.3*11.5 mm]; 14 and 16 [area 5*10 mm]; 25 [area 5*10 mm]; and 26 [area 5*11.5 mm] (NobelReplace/Select/Conical/Connection, Nobel Biocare)) splinted with a bar, all the six implant threads were exposed (>= 5 mm), hyperplastic soft tissue around the implants and exposed reconstruction plate on the left buccal area (Figure 1).
case_images: Orthopantomography showing marked bone loss.
case_images: CRID2025-7502566.002.jpg
case_images: PMC11756935_01_CRID2025-7502566.002.jpg
case_images: fig2
case_images: An orthopantomography was done to evaluate the extent of bone loss which revealed marked bone loss (Figure 2).
case_images: Granulation tissue removal using a plastic Gracey curette.
case_images: CRID2025-7502566.003.jpg
case_images: PMC11756935_01_CRID2025-7502566.003.jpg
case_images: fig3
case_images: After achieving the closure of the exposed reconstruction plate, excess peri-implant soft tissue was removed using a laser, and peri-implant curettage was done using a plastic Gracey curette (Figure 3).
case_images: Isolation using a rubber dam to prevent titanium particle ingestion.
case_images: CRID2025-7502566.004.jpg
case_images: PMC11756935_01_CRID2025-7502566.004.jpg
case_images: fig4
case_images: A rubber dam was used for isolating the implants to prevent the aspiration of titanium particles into the oral cavity and surrounding tissues (Figure 4).
case_images: Well-healed soft tissue.
case_images: CRID2025-7502566.005.jpg
case_images: PMC11756935_01_CRID2025-7502566.005.jpg
case_images: fig5
case_images: Marked soft tissue health was achieved a week after all these procedures (Figure 5).
case_images: Jaw relation record after lower anterior teeth preparation.
case_images: CRID2025-7502566.006.jpg
case_images: PMC11756935_01_CRID2025-7502566.006.jpg
case_images: fig6
case_images: Simultaneous endodontic treatment and tooth preparation were done to correct and align the lower anterior teeth, and later, jaw relation was recorded (Figure 6).
case_images: Splinted metal bar.
case_images: CRID2025-7502566.007.jpg
case_images: PMC11756935_01_CRID2025-7502566.007.jpg
case_images: fig7
case_images: A bar is fabricated with adequate soft tissue clearance for housing two sleeves anteriorly and ball attachments posteriorly on both sides to distribute the stresses evenly and to prevent any unwanted movement during function (Figure 7).
case_images: Finished prosthesis in occlusion.
case_images: CRID2025-7502566.008.jpg
case_images: PMC11756935_01_CRID2025-7502566.008.jpg
case_images: fig8
case_images: Once the final occlusal corrections are made, the permanent splinted crowns are cemented using glass ionomer cement (Figure 8).
case_images: Orthopantomogram during the follow-up visit.
case_images: CRID2025-7502566.009.jpg
case_images: PMC11756935_01_CRID2025-7502566.009.jpg
case_images: fig9