Maxillary Sinus Graft, Implant, MTM(Minor Tooth Movement), Oral Scanning > DENTAL FORUMS

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  A 60-year-old female patient had her teeth extracted about half a year ago. She had a cholecystectomy history and had been taking osteoporosis medications every week.

  A maxillary sinus graft (staged) and 2 implants placement were scheduled. Due to unexpected tilting of the distal tooth during the waiting period for the osseointegration period, minor tooth movement was needed. 


1. Initial photo. Two teeth were extracted about half a year ago.



  2. panoramic radiograph was taken to check the upper edentulous area.



  3  CBCT scan image after laterally approached sinus graft.


  4. Intra-oral photo was taken on the day of implant placement.
 

  5. 2 implants were placed using a series of ridge expanders - ARUMDENTISTRY Co. NB-1 Ø4/10 (30Ncm) at the premolar zone and  NB-1 Ø5/10 (20Ncm) at the molar zone
 

  6. Slight GBR was performed according to conventional GBR protocol and the flap was closed.


  7. Panoramic radiograph right after implant surgery.


  8. Gingival tissue punching was performed to expose fixtures. The 2nd molar showed unexpected mesial movement during the osseointegration period of the implant. 
 

  9. Intra-oral scanning was done to fabricate a tooth-positioning appliance for the 2nd molar distalization.
 

  10. 2nd molar movement simulation – before and after
 

  11. Resin attachment was made on the surface of 1st premolar to prevent unexpected tooth movement. . The patient was instructed to change the new appliance every 10 days.


  12. Tooth repositioning appliance (one of the series)

.

  13. After 2.5months of appliance wearing. an intra-oral photo was taken on the day of the ISQ measurement.


  14. ISQ value at the second premolar zone.
 

  15. ISQ value at the first molar zone.
 

 16. Scan-abutments were connected for digital impressions.


  17. A panoramic radiograph was taken to check the secure connection of scan abutments.
 

  18. . Intra-oral scanning to fabricate custom abutments and provisional resin crowns.
 
 
  19. The custom abutment, orientation jig, and provisional crown.
 

  20. Digital impression (intra-oral scanning) for the final restoration.


   21. The final prosthesis (zirconia)



  22. provisional crown was removed.


  23. Seating trial
 

  24. cementation and access hole filling.
 

  25. Panoramic radiograph after restoration.

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