Surgical & Prosthetic procedures
A mucoperiosteal flap was elevated to expose the palatal and buccal bone, and the extraction of tooth #25 with resection of the cyst in the same location was performed (Fig 4-6).
Alveoplasty of the maxilla and exposure of the nasal cavity was performed with a sub-nasal lift procedure to have a bicortical anchorage of the anterior axial implants protecting the nasal membrane (Fig 7-9). Implant osteotomies were performed with tilting orientation 30º for posterior implants in position #16 & #25, avoiding the pneumatized maxillary sinuses; and two axial implant osteotomies in position #12 & #22, to achieve an implant apical anchorage in the nasal floor (Fig 10-13). We selected 2 Straumann® BLX 3,75x18mm Roxolid® SLActive® for posterior tilted implants and 2 Straumann® BLX 3,75x12mm Roxolid® SLActive® for anterior axial implants (Fig 14,15). The insertion of the Straumann BLX implants were perform obtaining optimal torque values of at least 35 Ncm for all implants, being able to perform a predictable immediate loading of the prosthesis (Fig 16-20).
We placed two straights Screw-retained Abutments diameter 4.6mm, GH 3.5mm for the anterior implants and two Screw-Retained Abutments 30º diameter 4.6mm, GH 4.5mm for the posterior tilted implants (Fig 21-22). Moreover, we performed a guided bone regeneration procedure with Straumann® Xenograft and a Straumann® Membrane Flex™ in the containing bone defect located on the mesial area of implant position #25 (Fig 23). Flap was closed with free-tension sutures.
A panoramic radiograph post-op was taken before continuing with the prosthetic steps for the manufacturing of the immediate loading prosthesis (Fig 24,25).
Following the loading of the provisional prosthesis, a Cone beam computed tomography (CBCT) was taken and a correct stabilization and fit of the prosthesis was assured. Clinical front-lateral pictures were also registered.