implants the journal of oral implantology United Kingdom Edition

32 I I case study _ Atrophic maxilla implants2_2012 Lymph nodes: Clear Muscles of mastication: Appeared normal and with functional limits Facial muscles: Exhibited atrophy on the left side and the reduced function of the following muscles: • Depressor Anguli Oris • Mentalis • Zygomaticus Major and Minor The most distinct element we ob- served was when the patient smiles only the right side of the muscles used in smiling were functional. However the patient was aware of this and un- derstood that we would work in har- mony with the current Neuromuscular function. There also was a obvious loss of maxillary bone and support to the soft tissues. And an decreased OVD was also present. All however of these is- sues were corrected by the use of a well-constructed full denture replac- ing these areas and supporting the soft tissue. _Intra- Oral examination Soft tissues were clear and free from any pathological signs Dental Examination: Lower dentition was stable, Oral hygiene was good and BPE no more than one. Heavily restored molars and another eight remaining teeth present. _On discussion After the examination we discussed with the patient the various forms of treatment available and also potential levels of investment required for these options listed below: 1. A complete upper denture 2. An upper denture retained by four implants and splinted with a bar 3. A screw retained hybrid bridge on six dental implants replacing facial sup- port and utilising prosthetic replace- ment of tissue support but with no grafting or sinus work 4. A full hard and soft tissue recon- struction with hip grafting and up to eight dental implants and a cement re- tained bridge After discussion the patient opt- ed for the screw-retained prosthesis based on six dental implants and de- Fig. 4 Fig. 5 Fig4_RepresentationofA-PSpread conceptneededforcantilevering forces. Fig5_MetalFrameworktry-in