IM0110

14 I I case report _ implant placement Fig. 9 _Three semi-precision attach- ment fixed restoration. Fig. 10 _One year follow-up. Fig. 11_Extremely deficient maxilla. Fig. 12_Final fixed restoration. Fig. 13_Supra-frame screw retained. Fig. 14_Fixed prosthesis showing great facial reconstruction. implants1_2010 suprastructure for a totally implant-borne restoration with tissue contact only for speech (Figs. 4 & 5). _Fixed crown and bridge-type restoration Six to eight implants in the anterior and poste- rior maxilla are used to support a suprastructure for totally implant-borne cases. Implants are placed from the canine region extending posteri- orly, with a minimum number of implants placed into the incisal region. This placement pattern makes the design of the anterior portion of the prosthesis easier (Fig. 6). _Placement of eight implants with sinus graft for a fixed crown and bridge-type restoration Thesepatientshavehadtreatmentplanningfor an implant-borne restoration (crown and bridge type),yettheyhadinsufficientverticalboneforthe placement of implants in the posterior to the ca- nines.Thesinusgraftcanbeperformedasonesur- gery, followed by implant placement six to eight months later (Fig. 7). Alternately, the sinus graft can be performed and the implants placed at the time of the sinus graft (Figs. 8–10). Ifthesoftandhardtissueisextremelydeficient (Fig. 11), the lost structures can be replaced by a supra-frame that will restore the vertical dimen- sion and the teeth can be replaced with cemented oncrowns(Figs.12–14).Thistypeofprosthesisal- lows great facial reconstruction and support._ Editorial note: The literature list can be requested fromtheauthor. Fig. 11 Fig. 12 Fig. 9 Fig. 13 Fig. 14 Fig. 10 Suheil M.Boutros DDS,MS Assistant Professor, Department of Periodontics, University of Michigan Periodontal Specialists of Grand Blanc 8185 Holly Road,Suite 19 Grand Blanc,MI 48439,USA Tel.:+ 1 810 695 6444 Fax:+ 1 810 695 4414 E-mail:sboutros@umich.edu _contact implants