Cortical steroids were administered for the first two postoperative days. A postoperative 10-day cycle of antibiotic therapy (amoxicillin 1000 mg TID) was administered. Analgesics were administered as required. Sutures were removed 15 days after surgery. A soft diet was recommended for the first 2 weeks.

Three months afterwards, healing abutments were connected (Fig. 2) [4].

Approximately 4 weeks after healing abutment connection, intraoral defect including implant abutment and extraoral paranasal defect impressions were taken. The technician managed two different casts: one cast for nasal wax up and one cast for dental wax up. Superior implant bar supported by [4] zygoma implants was designed crossing the palatal defect in order to manufacture palatal obturator at a second time. Furthermore, two metal abutments were lodged and fused on the cranial surface of the bar in order to receive epithesis attachments. The abutments acted as primary crowns and secondary crowns, press-fitted on abutments and were used to take an extraoral position impression of the abutments using the nasal wax up as an individual. In this way, the technician could connect OTK (Ball abutment) attachments on the internal surface of the epithesis and thanks to secondary crowns, the nasal prosthesis can be removed for prosthetic aftercare and follow-up inspections. OTK attachments are commonly used because of their retention in overdenture prosthetic rehabilitation. The female part of this peculiar type of ball attachment is made out of Teflon™ (politetrafluoroetilene) while the male part consisted of a titanium structure. A complete implant-supported bar with two bolt prosthesis was made in order to provide superior arch rehabilitation. At the time of delivery, the palatal defect was closed by a soft base material. The nasal epithesis was made of silicone with an acrylic resin internal plate hosting female OTK attachments, whereas male parts were on the secondary crowns.

The patient received an implant-supported intra/extraoral rehabilitation with nasal epithesis and overdenture connected at the same metal framework due to the presence of an oronasal iatrogenic communication (Fig. 3). The nasal defect was classified into total (soft and hard tissues) rhinectomy. The palatal defect was localized at the premaxilla and was classified into “good” defect (resection margins into hard palate). Following the delivery of the prostheses, the patient showed satisfaction both for aesthetic and functional results and reverted to normal life achieving social integration (Fig. 4); he also reduced anxiolithic and antidepressive drug intake according to psychiatric counselling, and he is waiting to gradually stop them definitively. The patient did not receive radiotherapy and was non-smoker, two factors that are known to influence the success of implant therapy. He started an implant and prosthetic aftercare program.