A digital smile design was used to create an average smile and to develop a removable interim restoration for an edentulous patient with a high smile line and different bone levels in the maxilla.
Bone levels after sinus floor elevation were compared to bone levels in follow-up (Fig. 1).
Bone density was measured at the alveolar and basal bone levels in Hounsfield units (HU) using bone mineral density software (Siemens VA20A_SP3A, Munich, Germany) incorporated in the CT machine.
Radiographs showed satisfactory bone levels in conventional implants of oral rehabilitation with zygomatic implants and a good positioning of the apex of the zygomatic implants in relation to the zygomatic bone.
Furthermore, the radiological analysis revealed a stable bone level in all implants 3 years after loading.
The highest cortical bone density was observed between the second premolar and first molar at the alveolar bone level and between the first and second molars at the basal bone level in the maxilla.
They were embedded in epoxy resin, with a thermocouple (TC-08, Pico Technology, St. Neots, Great Britain) glued to the outer implant surface, at a level corresponding with the anticipated marginal bone level in uncompromised conditions.
The mean change in crestal bone level in the FAS 6 months after implant placement was 0.56 ± 0.58 and 0.51 ± 0.62 mm in the early and conventional loading arms, respectively, while at 12 months, it was 0.78 ± 0.61 and 0.73 ± 0.77 mm, respectively.
The mean change in crestal bone level in the PPS 6 months after implant placement was 0.56 ± 0.58 and 0.51 ± 0.62 mm in the early and conventional loading arms, respectively, while at 12 months, it was 0.76 ± 0.60 and 0.73 ± 0.77 mm, respectively (Table 4 and Fig. 4).
Thus, standardized peri-apical radiographs seem so far to be the method of choice to monitor bone level in longitudinal clinical interventions trials.
