CAD/CAM Magazine

After its osseointegration, we incorporated a com- pletelynewbridgeusingtheexistingmesialimplant. The results achieved here can help us learn from design errors and select a different approach for future cases, so that we can also treat patients who have had failure of a comprehensive prosthetic restoration.Ourlastcasewillillustratethissituation. _The unsuccessful conventional treatment versus the successful, well-planned implantological procedure (Figs. 21–34) Theproblem Finally,wewouldliketopresentanunusualcase: an unsuccessful conventional treatment that was replaced with implantological treatment carried out in close collaboration between the dentist anddentaltechnician.Thepatienthadexperienced considerablecomplicationsduringprosthetictreat- ment(thegoalbeingatelescopicpartialprosthesis supported by teeth #43 and 33, while preserving the front teeth #42 to 32, which had been caries- free and without fillings until then, and replace- ment of teeth #47 to 44 and 34 to 37). First, tooth #33 fractured and had to be extracted, in spite of the fact that preparation and casting had already been done. Treatment was replanned after this event, and teeth #42, 41, 31 and 32 were also pre- pared (the goal being telescopic crowns). Shortly before implementation, tooth #43 also had to be extracted. The patient was unable to give the exact reasons for this. This left her with four teeth—#42, 41, 31 and 32—which all had telescopic crowns. Figs.21–25_Owingtothelossof prospectiveabutmentteeth#43and33 duringtheprosthetictreatmentphase, theremainingfrontteeth#42,41,31 and32receivedtelescopiccrowns. Fig. 26_The partial prosthesis showed insufficient mounting. Figs. 27–29_With the aid of 3-D imaging and planning, four implants were inserted in regions #46, 43, 33 and 36—without any augmentative treatment. Fig. 30_After osseointegration of the artificial abutment teeth, two side-tooth bridges entirely supported by implants and four individual crowns were integrated with the remaining mandibular teeth. Fig. 31Fig. 30 Fig. 28 Fig. 29Fig. 27 Fig. 25 Fig. 26Fig. 24 Fig. 22 Fig. 23Fig. 21 22 I I clinical technique _ implant-prosthetic troubleshooting CAD/CAM 2_2011