Multiple Crowns

Complex Rehabilitation of Upper Jaw by Dr. Arny

In my humble opinion, this is the most difficult problem during rehabilitation and sometimes, it is the one dictating our treatment plan.

Here we have a case where the upper ridge, completely ruined, is about to go through a complete extraction (pic. 1). The main problem in the area is the front segment where the bone is severely damaged (pic. 2, 3).

It is obvious to us that an extraction will be followed by two problems:

1. Severe bone damage and shortage of gum tissue, making the closing of the augmentation site difficult.
2. The patient’s unwillingness to perform sinus lifts, affecting the treatment plan as well.

The treatment plan was consisted of three stages:

1. It has been decided that teeth 13, 15 and 24 will be left to support the temporary rehabilitation and therefore they have been treated by a root canal treatment.
The extractions have been done in this stage, during which the enormity of bone damage has been revealed (pic. 4). Bone grafting (Gen Os) and Evolution membrane (both by OsteoBiol) have been used (pic. 5). The patient has been fitted with a temporary bridge and this is how it looked about two weeks after the surgery (pic. 6).

2. The second stage, three months late, another surgery has been done, where five ARDS implants have been used (implant 25 in closed sinus lift) and additional augmentation of the ridge (using Gen Os). A special thin membrane (Special – OsteoBiol) has been used here.

3. The third stage, after four months, the exposure of the implants has been done. Picture no. 7 shows comprehensive absorption of the ridge on the vertical dimension. This clearly demonstrates why in this kind of rehabilitation we must wait the necessary time periods and not rush as we cannot predict how the bone and gums will react to such comprehensive manipulations.

As teeth 13, 15 and 24 have stayed stable during the treatment, it has been decided to leave them in the mouth and shorten them on the vertical dimension.

Abutments have been fitted (pic. 8), measurements have been taken (pic. 9) and the work has been completed (pic. 10, 11).
The final rehabilitation in the patient’s mouth can be seen in picture no. 12