Complete Reconstruction with Grafting and Implants

This 60 year old man had been wearing a complete upper denture for 35 years and as such was no longer able to function properly. His denture was loose and he had undergone severe resorption. Additionally his lower posterior areas were also severely resorbed. His main goal was to have fixed teeth that he could eat and smile with confidently.

Due to the severe resorption on the maxilla both in width and height and pneumatization of the sinuses multiple grafting procedures had to be undertaken to reconstruct the maxilla. There was no possibility of block grafts due to the maxillary sinuses extending to the inferior border of the maxilla all the way to the canine regions. Step one was to perform direct bilateral sinus lifts and particulate bulking up of the maxilla both facially and palatally. Once healed the maxilla was further grafted for width and finally at implant placement a ridge splitting technique with further grafting was undertaken. 10 implants were placed in the maxilla and ultimately 7 implants in the mandible with the posterior implants tilted at 35 degrees to allow the head of these to be placed as far posteriorly as possible over the mental foramina.

Lower prosthetics for this case included a fixed titanium framework with composite teeth and pink tissue to allow for the teeth to be placed at the proper vertical dimension. The maxillary prosthetics are removable for cleaning and are retained by a friction fit between a precision milled framework with gold posts and copings. This treatment completely changed this man’s life. All work was performed by Dr. Arvanitis.