Clinical case of the month

Reconstruction of the upper jaw after removal of three 2-stage implants (affected by peri-implantitis) and removal of all remaining teeth.

Case solved by:
Dr. Antonina Ihde & Dr. Stefan Ihde , OSA Simpladent, Montenegro
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Fig. 1: A female patient without generalized diseases, turned up in our dental office about 6 months after her lower jaw had been equipped with the Strategic Implant® at successfully and uneventfully. She requested as solution for the upper jaw, which presented the following problems: three 2-stage implants were affected by vertical and crater like bone loss. All of her teeth showed profound periodontal involvement, her front teeth were slightly mobile.

Fig. 2: Intra-oral view of the pre-operative situation: Overly long crowns on three 2-stage implants and the exposed rough surface of the implants are visible. The frontal-group appears crowded and shows caries.

Fig. 3: Shows the micro-theaded 2-stge implants (of french origin). The implants are positiones quite vestibularly and their removal was easily possible: the degree of mineralitation at the reminaing osseointegrated surfaces of hte implants was apparently low. Following the remocal oft he implants, all teeth were also removed. In order to reduce the vertical step between the frontal zone and the distal zone of the upper jaw, around 6 mm vertical (crestal) bone in the frontal area was removed also (in an open flap procedure), and a total of 14 endosseous Strategic Implant® were placed and anchored in the 2nd and 3rd costical, according to the methods which had been defined in Strategic Implantology.

Fig. 4: Shows the clincial overview on the 3rd post-operative day right after the removal of all sutures and before the final cementation of the full apper jaw bridge.

Fig. 5: shows that in the left upper jaw the new implants are placed more palatal than the old (former) implants.

Fig. 6: Shows the incorporated metal-to composite bridge on day 3 after the operation. The vertical step has been treated successfully by: partial removal of bone and alignment oft he soft tissues, and by incorporating a bridge including a composite shield. Without lifting the upper lip with instruments it would not be possible to see the transition area between the natural gums and the gums made from composite. The teeth were chosen similar in shape compared to her own teeth, the patinet did not request to copy her former anterior crowding.

Fig. 7: Shows the smart and happy smile of the patient and the well supported upper lip. During the following days adjustments regarding occlusion and mastication between the upper and lower jaw were done before the patient was allowed to leave and go back into her normal life with the treatment accomplished.

Fig. 8: Post-operative panoramic overview picture with both bridges in place and regular 2nd cortical anchorage for all Strategic Implant® except the lower inter-foraminal area.

Summary The upper and the lower jaw of the patient were treated in two separate treatment sessions within three days with fixed bridges in the Strategic Implant®. In the upper jaw several periodontally involved teeth had been removed as well as three implants, which ad been affected severely by „peri-implantitis“. No healing time nor bone augmentations were necessary, since restorations on the Strategic Implant® are routinely placed even in case with pronounced atrophy in the protocol of Immediate Loading.