CAD/CAM Magazine

Anchoring of the partial prosthesis was poor; the patient was able to loosen it with minimal tongue- applied pressure. The pronounced tendency of the prosthesis saddles to cave in also resulted in com- plications in the form of multiple recurrent pres- sure sores. The patient was referred to us at this point. The reason for this according to her dentist was that implants, which the patient had inquired about, could be inserted neither in the extended front-tooth area nor in the side-tooth area owing to the narrow and atrophied alveolar ridge. Oursolution It was true that the alveolar ridge on both sides, starting with the cuspid region and extending to the area where the molars had been previously, was fairly pointed, and the course of the osseous limbus alveolaris displayed a pronounced sagging distally of the previous pre-molar zone. The patient thus showed considerable osseous deficits in both the oro-vestibular and horizontal dimension. In order to assess the basic possibilities of oral implants, we decided to perform 3-D imag- ing, which proved extremely helpful in this com- plex patient case. After illustration of the osseous situation,therewereindicationsthatimplantation would be possible without carrying out augmen- tation procedures. We then prepared a virtual implant plan, the results of which led us to prepare a drilling template. Theremainingfrontteethprovedveryhelpfulas a place for securely anchoring the template. By opting for a shortened row of teeth with one im- planteachintheregionoftheformersix-yearmo- lars and an additional artificial abutment in each oftheformercuspidareas,wewereabletokeepthe dimensions of the template relatively small. The insertion of four implants in the regions of teeth#46,43,33and36andtheirosseointegration were followed by treatment with the supra-struc- tures, which consisted of two bridges in regions #46 to 43 and 33 to 36, entirely supported by implants, and four individual crowns on the front teeth. The restorations were temporarily affixed for six months and then cemented in place._ Figs. 31–33_Three-dimensional diagnosis and planning (see dental pins) of the third and fourth quadrant. Fig. 34_Orthopantomogram after incorporation of four implants, three of which were diameter-reduced Roxolid (Straumann) implants. Dr Georg Bach Rathausgasse 36 79098 Freiburg/Breisgau Germany doc.bach@t-online.de MDT Christian Müller Carl-Kistner-Straße 21 79115 Freiburg/Breisgau Germany chmue10@aol.com CAD/CAM_contact Fig. 33Fig. 32 Fig. 34 24 I I clinical technique _ implant-prosthetic troubleshooting CAD/CAM 2_2011