CAD/CAM Magazine

20 I I clinical technique _ implant-prosthetic troubleshooting CAD/CAM 2_2011 design flaws, there is additional, yet different implant-prosthetic troubleshooting—covering pri- marily implant fractures or failure of individual implants within an extensive supra-structure. This considerably smaller part of implant-pros- thetic problem areas, as compared with the group of design errors mentioned above, will be cov- ered and evaluated in this article. The purpose of this is to demonstrate solutions so that the patients affected receive a modified solution in order to preserve the existing and very expensive work. _Loss of implant due to peri-implantitis (Figs. 9–18) Theproblem A bridge structure in the second quadrant had been in place without any problems in a 50-year- old female patient for 10 years. Therefore, she only came to recall and follow-up examinations spo- radically. The problem-free period ended abruptly when swelling and bite pain occurred in the left half of the maxilla. A panoramic tomography revealed radiological indications of a profound osseous defect around the mesial implant, which had to be removed on the same day. The issue then was the entire supra-structure. The patient in- sistedthatthisstructurebepreservedowingtothe financial cost of having a new structure created after re-implantation. Oursolution Anewimplantwasinsertedafterthesofttissue and bone had healed in the area where the lost implant had previously been in place. The bridge structure that had been temporarily affixed on the remaining implant was used as guidance for Fig. 9_The mesial abutment tooth of a bridge entirely supported by implants in the left maxilla was lost. After healing of the soft tissue, a further implant was inserted in a position as close as possible to the former implant position. The illustration shows the dental master model with the customised abutment. Fig. 10_The former bridge structure was used as a customised “spoon” for the newly added implant so that a customised abutment could be created for the additional implant to be mounted distally (note the loss of vertical distance) for use in the existing restoration. Fig. 11_Customised abutment tooth as a terminal abutment. Fig. 12_Patient’s oral condition. Figs. 13 & 14_We were able to preserve the bridge in the left maxilla. Fig. 14Fig. 13 Fig. 12Fig. 11 Fig. 10Fig. 9