Fixed restoration of the upper anterior jaw

The challenge in a situation like this is to prevent collapse of the anterior ridge once the teeth are removed. At the outset the remaining incisor teeth had very thin labial bone covering them. This thin bone can resorb very quickly, leaving insufficient bone to house implants. To help the recovery, it is always useful to have a good covering of soft tissues. In this case, vertical incisions were taken on the distal of the canine and between the right central and lateral. It might have been simpler and safer to raise a single flap from premolar to premolar. It could have prevented the loss of soft tissues in the regions where the incisions were made. Augmenting the region with bone grafts when the teeth were removed is obviously the way to go, but where the bone plates are so thin it would be useful to augment outside as well as inside inside the sockets. Calcium sulfate/phosphate graft materials tend to dissolve during the healing period, to be replaced by natural bone growth. There are other materials which are much slower to resorb which would help. It would also be useful to thicken the soft tissues in the region and this could be provided by placing a thicker collagen graft(s) over the bone graft. This may sound more involved and complicated, but by starting with a full thickness flap from premolar to premolar it would be possible to remove the failing teeth, debride the region, perforate the labial bone, augment internally and externally and then place the membranes to protect the bone and thicken the soft tissue complex. Many operators would also consider placing implants at the same time. At this stage you should consider that raising a premolar to premolar flap and expanding the ridge with exterior bone grafts may be useful and required when placing the implants. Good luck with this case. I hope this helps. Best wishes.