In this case, the goal wasn’t simply to treat the teeth—it was to design a complete treatment journey that restores function, aesthetics, and the patient’s confidence.

The treatment plan began with removing the old bridges and any teeth that could not be preserved, followed by immediate implant placement using precise, surgically guided planning. During the healing phase, which lasted several months, carefully designed temporary restorations were used to ensure the patient’s comfort while maintaining both function and an acceptable aesthetic appearance.

Once full implant integration was confirmed clinically and radiographically, we moved forward with the final full-arch bridge rehabilitation. Tooth positioning, shape, size, and the new smile line were meticulously planned to harmonize with the patient’s facial features and natural esthetic principles.

We believe that a treatment journey with Dr. Tammam Saqr is not a quick procedure, but a carefully structured plan—built step by step—to ensure comfort, safety, and a healthy, natural-looking smile that lasts, God willing.

An increase in gum volume and excessive coverage of the tooth surface may occur as a side effect of orthodontic treatment or due to other medical reasons. In such cases, there is a need to remove the excess gingival tissue—commonly referred to as “gum trimming.” This is a relatively simple procedure performed under local anesthesia using a laser, which makes it easier and less uncomfortable for the patient, while also enhancing the beauty of the smile.

In this case, digital surgical planning was performed for implant placement in the anterior region of the maxilla, based on immediate implant placement directly after tooth extraction using a surgical guide. This allowed the implant axes within the bone to be oriented sagittally at an angle approximately 30 degrees less than that of the natural teeth, in a way that ensures a reduction of the final prosthetic protrusion over the implants by several millimeters toward the palatal side. This, in practice, is comparable to performing orthodontic tooth movement.

In addition, the protrusion of the maxilla was surgically modified through alveolar bone reduction, which contributed to decreasing the prominence of the upper lip supported by it. The protrusion of the mandibular teeth was also corrected by changing the prosthetic restorations to axes inclined toward the lingual side. Ultimately, this led to a reduction in muscular tension of the lips and provided the patient with a feeling of comfort during smiling and speaking, while also resulting in a radical improvement in the overall facial profile.

In this case, the height of the alveolar bone adjacent to the maxillary sinus was limited to approximately 3 mm, which was insufficient to perform implant placement without sinus floor elevation.

The treatment plan involved performing a sinus lift through external approach, placing the appropriate bone graft material, and simultaneously inserting two dental implants during the same surgical session.

After a healing period of four months, radiographic evaluation confirmed a successful osseointegration between the host and the grafted bone, and with the implants. This was followed by exposure of the implants and starting the prosthetic phase, which took approximately one month to complete.

Outcome:

• Stable integrated implants in bone with height of 10 mm
• Restoration of normal masticatory function on the treated side
• Reduction of total treatment time from 8 months to 5 months due to simultaneous implant placement with sinus elevation

Conclusion:

Successful treatment begins with accurate case assessment, followed by well-structured planning, and is completed through precise execution of each clinical phase.

Success ultimately depends on disciplined planning and careful surgical performance.

This case represented a real challenge, as the choice was somewhat difficult between first performing horizontal bone augmentation and performing implant placement and bone grafting simultaneously.

The alveolar ridge was extremely thin, presenting as a “knife-edge ridge,” with a bone thickness of only approximately 1.5 mm at the crest. However, the bone thickness at the base was, in principle, sufficient to place the implant along an appropriate axis for the future prosthetic restoration and to ensure implant stability.

Since the prognosis for implant placement in this case was positive, it was planned to perform implant placement and horizontal bone augmentation at the same time, in order to save time and spare the patient an additional surgical procedure.

Following careful planning using CBCT imaging, two implants were placed, and horizontal bone augmentation was performed using a titanium-reinforced membrane to maintain the required space and protect the bone graft during the healing period.

This approach is considered one of the advanced techniques that can achieve highly predictable results when the case is selected carefully, the surgical procedure is planned correctly, and the bone graft and membrane are managed with expertise.