CAD/CAM Magazine

incorporation of a replacement implant and then removed for the actual implant procedure. Afterosseointegrationoftheartificialabutment tooth, we inserted a plastic abutment and made a castingoftheintegratedbridgestructurewithpoly- ether casting material. This customised abutment was transformed into metal and the bridge struc- ture finally cemented in place after a trial insertion. _Implant fracture (Figs. 19 & 20) Diameter-reduced implants can often be im- plantedeveninareducedosseousbedandaidinthe avoidanceofaugmentations.However,whenintro- duced into the market, diameter-reduced implants were frequently used for other indications as well; some clinicians even recommended using them as standard implants. Stress phenomena caused a considerable number of implant fractures, result- ing in markedly restricted indications for diameter- reduced implants. Theproblem The case presented here reflects the typical progress of this early phase. A purely implant- supported (two abutments) extension bridge was incorporated into the fourth quadrant. A diame- ter-reduced implant was used in spite of an oro- vestibular bone dimension that would have been sufficient for supporting a standard implant. The result was that the distal implant fractured after eight years. Oursolution In one surgical session, we removed both the implant fragment remaining in the bone by way of an osteotomy and placed a further distal implant. Fig. 15_Three implants had originally been inserted to treat anodontia in the second quadrant. Figs. 16 & 17_The distal implant was lost; the detailed view shows the non-functional crown #25. Fig. 18_Condition after re-implantation distally of the implant localisation. Fig. 19_The distal (diameter-reduced) implant of a bridge supported entirely by fractured implants. Fig. 20_An additional implant was inserted distally after removal of the fragment that had remained in the bone. After integration of the implant, a new bridge supported entirely by implants was created, while incorporating the former implant. Fig. 20Fig. 19 Fig. 18Fig. 17 Fig. 16Fig. 15 I 21 clinical technique _ implant-prosthetic troubleshooting I CAD/CAM 2_2011