Retreatment of a failed All -on -4+ case with tissue regeneration四植体+全瓷牙列失败病例的再治疗( 通过组织再生技术)

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·       63 YO,  Female ,   63 岁，女性。

She received All- On -4+ treatment on the upper and lower arches in the US, but within one year after treatment ,   all the implants on the upper arch fell out one after another.  她在美国的一间牙科诊所接受了上下颌 的四植体+全瓷牙列的治疗， 然而不到一年， 上牙颌的所有种植体先后松动脱落。

·       The CBCT scan and implant planning software clearly point to the cause of the failure: the upper residual ridge did not have sufficient bone foundation for the implant treatment, even the previous right sinus bone graft did not generate enough bone volume for the implant placement. Therefore, bilateral sinus lift and ridge reconstruction are needed before the retreatment of the implants. CT扫描和种植软件分析清楚地指向此前治疗不成功的原因在于：上颌牙槽骨严重萎缩，缺乏植牙的骨量基础， 甚至于此前的右侧上颌窦提升植骨都没有产生足够的骨量。 因此, 再次种植治疗前， 需要双侧的上颌窦提升植骨和牙槽嵴的植骨重建。

First step of the retreatment--placed an implant into the nasopalatine duct together with bone graft, waited 3 months till it integrated with bone. This first implant will serve to support the upper denture the patient was wearing, protecting the bone graft in the next step from the denture pressure.   治疗的第一步是植入鼻腭管植体， 3个月后用此植体支持上颌假牙， 以使下一步骤的植骨免受假牙的压迫。

Second step, bilateral sinus lift and ridge reconstruction with autogenous bone blocks harvested form bilateral ramus area.   治疗的第二步是左右双侧的上颌窦提升植骨和采取双侧下颌升枝自体骨移植的牙槽骨重建。

The CBCT scan and virtual  implant placement in the implant planning software 4 months after sinus lift and ridge reconstruction, which shows adequate bone volume has been regenerated to allow for the retreatment of implants. 双侧上颌窦提升植骨和牙槽嵴重建后的CT扫描和软件分析， 显示再生的骨量充分， 可以支持种植的再治疗。

Third step- Four more implants were placed into the precise locations by using computer generated  and 3D printed surgical guide, four months later, clinical tests confirmed all five implants successfully integrated with the surrounding bone.  治疗的第三步是采用电脑设计， 三D打印的种植导板， 四颗植体精准地种植在合理的位置上， 四月后临床检验证实上颌五个植体全部成功实现骨结合。

Successful retreatment outcome of this very complex All -On -Four+ case, at one year follow up visit, all the implants were found firm in place and surrounding gingiva and bone tissue very healthy. 

四植体+全瓷牙列复杂病例的成功再治疗， 一年后随访发现所有的植体稳固， 周围的牙龈和骨组织健康正常。