Dental Tribune United Kingdom

August 1-7, 2011United Kingdom Edition page 19DTß For effective infection control, the UltraClean II Washer Disinfector Dryer helps you protect your patients, your staff and your reputation. Patient safety rests in your hands Designed as the rst step in an integrated decontamination process, the UltraClean II prepares your hand pieces better than many other methods. Fast, ef cient and very thorough, it washes, cleans, disinfects and dries – leaving instruments spotless and ready for sterilization. • Fully compliant to EN 15883 and HTM2030 – the recommended ‘best practice’ standard • High load capacity and only 30p per cycle for fast, cost-effective cleaning • Optional data logger or printer for easy, recordable data capture – essential for compliance • Automated process using the special clip trays supplied helps eliminate sharps injuries INTEGRATED DECONTAMINATION SOLUTIONS Prestige Medical – the first company with a series of solutions to ensure you stay on the right side of compliance with legislation. Products include decontamination cabinetry and furniture, washer disinfectors, autoclaves and sterilizers, data recorders and printers. We can also provide advice on the latest guidelines. For more information Tel: 01254 844 103 E: sales@prestigemedical.co.uk www.prestigemedical.co.uk Visit us on stand D30 The Dentistry Show 4-5 March 2011 NEC Birmingham scanning templates (Fig. 14). Surgery In cases of a large number of implants to be placed, our team likes to implement a two-stage implant placement procedure. The lower jaw implants are in- serted on the first and the up- per jaw implants on the subse- quent day. The patient was not subjected to general anaesthe- sia. It was possible to treat the phobic patient only with local anaesthesia without any prob- lems. The surgical template used in combination with a specifically matched surgical kit allowed for exact transfer of the 3-D computer planning to the patient’s mouth (Figs 15 & 16). As in the first case, Nobel Active implants were insert- ed, which afforded good pri- mary stability even under the strongly reduced bone condi- tions present in this case. This is owing to the special surface and the design of the implants. Following surgery, fixed tem- porary bridges, which had been fabricated ahead of time based on the existing planning, were inserted (Fig 17). Procera Implant Bridge As before, the definitive form of management selected in this case was a NobelProcera CAD/ CAM restoration. There were some particularities to take into account in the manage- ment of both the lower and the upper jaw. The true quality of the teamwork of dental office and laboratory becomes evi- dent in the smooth production of very sophisticated rehabili- tative restorations that can be fabricated without complica- tion and incorporated into the stomatognathic system of the patient without any difficul- ties. As part of the production of the restorations for the low- er jaw, the terminal molars (teeth #36 and 46) were fabri- cated as titanium single tooth crowns and screw-retained at implant level (Figs 18 a & b). It was thus possible to take into account the 3-D twist of the arching lower jaw bone such that tensions at the level of the distal implants were prevented, which might oth- erwise have caused bone loss or even implant loss. We only splinted interforaminally in the lower jaw, between teeth #35 to 45 (Fig 19). A distal can- tilevered pontic substituting for teeth #36 and 46 was not used in this case, as implants #45 and 35 were only NobelAc- tive implants with a diameter of 3.5mm. The Procera Implant Bridge Titanium on multi-unit abutments from teeth #35 to 45 was veneered completely, including gingival regions, using VITA titanium ceramic (Fig 20). As before, it was fea- sible to implement the screw retentions exactly according to plan such that no adverse aes- thetic effects arose. The far- reaching bridge was fabricated at the Nobel Biocare milling centre and was prepared for the veneering steps with only little time required for mi- nor details of post-production processing. Thanks to CAD/CAM tech- nology, it is possible to gener- ate frameworks that are truly free of tension. In this context, Nobel Biocare guarantees a precision of fit of less than 25μm. For aesthetic reasons, an elaborate form of re - storation was selected for the upper jaw. A Procera Implant Bridge Tita- nium on multi-unit abutments was produced. The bridge was designed to allow all-ceramic NobelProcera Crowns Alumina to be cemented to them. For this purpose, the framework was veneered with a gingiva- coloured ceramic material and opaquer was attached in the region of the stumps by fir- ing (Figs 21 & 22). In the next step, the single crowns were prepared (Fig 23). After com- pletion of the entire restora- tion, the basic framework was screw-retained in the mouth (Fig 24) and the aesthetic Procera alumina single crowns were cemented in the mouth using conventional cement (Durelon, 3M ESPE; Fig 25). Accordingly, the patient’s res- toration was still conditionally removable in the dental office, since the crowns covering the screw channels remained re- movable. This is advantageous for the patient in that the aes- thetic appearance of the upper jaw can be improved even fur- ther, while no screw channels are visible. This resulted in an excellent aesthetic appearance at the red–white transition (Figs 26 & 27). Conclusion In this article we have dem- onstrated a dental team being able to offer treatment based on a one provider concept that starts with a 3-D diagnostic work-up, allows for template- guided navigated implant placement, keeps in stock all implant and prosthetic compo- nents (as typifies the concept of Nobel Biocare), and offers nu- merous advantages, including: • application of a broad range of different techniques from a single supplier • only a single supplier needs to be contacted • implant and prosthetic com- ponents match • interfaces match • materials match • final result has a high preci- sion of fit • generous solutions if difficul- ties are encountered • custom-made designs for spe- cial needs Approaching the planning and implementation of an im- plant-borne restoration from the patient’s perspective and his or her needs will always cause the treatment team to place safety very high up on the list of its priorities. Based on the reli- able NobelGuide concept, the success of the team becomes a matter of planning. To have but a single supplier to contact for all necessary components saves time and the attend- ing team can rely on the per- fect match of all components. Another aspect that should not be underestimated is the increasing number of litiga- tions after unsuccessful out- comes. Products that have been tested in numerous scientific studies provide the needed va- lidity. 3-D planned and template- guided implant placement, aesthetically pleasing forms of restoration, and a long service life of the restorations also ap- peal to the patients. The dental office of Drs Grebe periodically organises courses in 3-D implantology and CAD/CAM prosthetics for dentists and dental technicians. If you are interested, please enquire about the dates of up- coming events by e-mail. We would like to thank our dental technicians Michaela Schenker, Frank Rödel and Jörg Parsaksen for their sup- port. DT Editorial note: A list of ref- erences is available from the authors. ‘To have but a single supplier to contact for all necessary components saves time and the attending team can rely on the perfect match of all components’ About the author Dr Götz Grebe & Dr Melanie Grebe Schwanenwall 10 44135 Dortmund Germany praxis@dr-grebe.de www.dr-grebe.de