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case_images: Pre-treatment periapical radiographs.
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case_images: fig1
case_images: Pre-treatment smile photograph.
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case_images: fig2
case_images: 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).
case_images: Schematic showing the steps of staged approach treatment plan.
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case_images: fig3
case_images: 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).
case_images: (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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case_images: fig4
case_images: Tooth # 5 was selected for extraction and GBR with tenting screw technology as part of the maxillary grafting procedures (Figure 4).
case_images: 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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case_images: fig5
case_images: Abutment teeth # 20, 22, 27, and 29 were used to retain a mandibular fixed provisional prosthesis (Figure 5).
case_images: Internal sinus lift and implant osteotomy prepared through the surgical guide for site # 14.
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case_images: fig6
case_images: Panoramic radiograph shows the placement of six implants per arch. Note metal-reinforced fixed provisional prostheses retained by retained teeth.
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case_images: fig7
case_images: The provisional pontic areas above the implants were relieved slightly to allow for minor swelling (Figure 7).
case_images: Soft tissue enhancement around lower molar implants, during stage 2 implant uncovery.
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case_images: fig8
case_images: 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).
case_images: 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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case_images: fig9
case_images: The screw-retained provisional prostheses were delivered at this point (Figure 9).
case_images: Flapless immediate one-stage implant placement at # 6 and # 11 extraction sockets.
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case_images: fig10
case_images: The sites were stabilized with Vicryl 4-0 sutures after easy removal of the mucosal-tooth-borne guide (Figure 10).
case_images: Photographs show patient's smile. (a) Pre-treatment. (b) During treatment.
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case_images: fig11
case_images: The provisional fixed prostheses were finished and polished around newly added temporary cylinders and delivered back to the patient (Figures 11 and 12).
case_images: Frontal views for patient's smile. (a) Pre-treatment. (b) During treatment.
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case_images: fig12
case_images: The provisional fixed prostheses were finished and polished around newly added temporary cylinders and delivered back to the patient (Figures 11 and 12).