Live WebinarRisikopatient und Lokalanästhesie – Was muss ich für die Praxis wissen?
26 Feb 2021, 04:00 PM Berlin
Priv.-Doz. Dr. Dr. Eik Schiegnitz
Owing to the periodontally insufficient anterior residual teeth in the maxilla (teeth #12, 11, 21 and 22), the prosthesis could no longer be supported. After losing the residual teeth, the patient wanted a fixed implant-based restoration of the maxilla.
The residual teeth of the mandible showed the following findings. Tooth #48 was impacted and displaced. Tooth #45 showed mobility (Grade 3) and was periodontally insufficient. The anterior residual teeth #33 to 43 presented with increased probing depths on the canine teeth and increased mobility (Grade 2).
The treatment strategy for the maxilla included, as a first step, a conservative periodontal therapy of the anterior residual teeth for strategic preservation and fixation of the existing prosthesis until implant insertion. Afterwards, the residual teeth were removed and a bilateral sinus floor augmentation was performed in a two-stage procedure. Following 3-D planning, eight endosseous implants were inserted with the CAMLOG Guide System in a flapless procedure, and the prosthetic restoration was realised using a telescopic bridge.
In the mandible, tooth #45 was removed and the other teeth were treated with conservative periodontal therapy. The mandibular posterior teeth were replaced and realigned. Teeth #43 to 33 received re-veneering of the removable denture.
The planned minimally invasive flapless procedure for implant insertion requires a unique fixation for the preparation of radiological materials. The fixation is facilitated by temporary implants in a suitable position. In order to ensure accurate transferability, the fixation must be performed under radiological control in the identical position as the one for the implantation.
The scan template is fabricated based on prosthetic requirements (functional, aesthetic). A bone-anchored and prosthetic-oriented scan can be taken under radiological control owing to the unique fixation of the scan template using the interim implants.
The thickness of the mucous membrane can be measured by fitting the radio-opaque tooth along the plaster surface. The distance from holding sleeve to bone surface must not exceed 3.5 mm.
CAD/CAM was used to fabricate the bridge framework from a fibre composite (Everest C-Temp, KaVo) and veneered with an acrylic material. For passivation of the design, proven electroplating was used. Custom CAD/CAM-fabricated zirconia abutments were selected.
The original goal of the prosthetic reconstruction was a fixed bridge restoration. Owing to the hygienic and functional training phase with the long-term temporary appliance, the patient opted for a removable bridge.
The accuracy and simplicity with which the implants can be inserted in prosthetically correct or anatomically difficult situations is increased significantly by virtual 3-D implant planning using CBCT or CT in combination with the guided implant bed preparation and implant insertion. Implant therapy is thus facilitated.
The drilling sequence in the CAMLOG Guide System is different from other systems. While in a conventional drilling sequence, the pilot drill is advanced to the final implant length, the drilling sequence guided by the CAMLOG Guide first starts with the shorter pilot drill (length 6 mm). To guide all drills by the sleeve geometry from the start, the drilling sequence is performed in succession from the 9 to the 11 mm drill and finally to the 13 mm drill (maximum implant length).
The CAMLOG Guide offers a sleeve system. As opposed to multi-sleeve systems, a single sleeve inserted into the surgical template is adequate for guidance during all drilling sequences and implantation procedures. The implants can be inserted through the sleeves._
Editorial note: The case was first published in C. Mairoana & M. Beretta (eds.), Manual of Oral Implantology (Edizioni Italia Press, 2010) and is reprinted here with kind permission.
A complete list of references is available from the publisher.