A 50-year-old patient presented with severely compromised maxillary dentition and complete absence of posterior maxillary bone bilaterally, with less than 1 mm of residual bone available for implant placement. The posterior teeth had been extracted several years earlier due to cystic pathology on one side and failed prosthetic treatment on the other.<\/p>\n\n\n\n
The remaining anterior teeth also had failing, long-standing post-and-core restorations, requiring comprehensive rehabilitation. The bite was reverse in this case.<\/p>\n\n\n\n
CBCT evaluation revealed severe bilateral posterior maxillary bone deficiency. Two treatment options were discussed: direct sinus lift with bone grafting or zygomatic implants if adequate bone regeneration could not be achieved.<\/p>\n\n\n\n
Bilateral direct sinus lifts were performed approximately 10 months ago using xenograft and PRF. After adequate healing and bone formation, two posterior implants were placed bilaterally using fully guided surgery.<\/p>\n\n\n\n
The remaining seven anterior teeth were extracted, followed by placement of four immediate implants using Nobel Biocare active implants with Tiultra surface for better soft tissue healing and through fully guided stackable bone level guide \/ stent approach. Bone grafting was done in sockets where there was more jumping distance between implant and buccal plate. The extractions were done atraumatically to preserve buccal plate. Primary stability was excellent, with insertion torque exceeding 35 Ncm. Multiunit abutments were placed on four implants for screw retained prosthesis.<\/p>\n\n\n\n
A fixed provisional restoration was delivered on the four anterior implants, providing an All-on-4 provisional prosthesis for aesthetics. The reverse bite was corrected in provisional prosthesis. Bredent PMMA with bar was given as provisional prosthesis. The posterior implants were intentionally left submerged and excluded from the provisional restoration to allow undisturbed healing.<\/p>\n\n\n\n
After the planned six-month healing period, the posterior implants will be incorporated into the final maxillary restoration.<\/p>\n\n\n\n
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