cone beam CE

cone beam1_2012 case study_removable bridge I Initial presentation Fig. 1_Panoramic radiograph. The maxillary posterior regions on both sides show significantly reduced vertical bone height (residual height less than 2 mm). Fig. 2_Clinical situation with removable telescopic prosthesis inserted. (Photos/Provided by Dr. Claudio Cacaci) Those involved in the 3-D treatment planning include: Dr. Claudio Cacaci Munich, Germany MDT Gerhard Stachulla Mühlhausen, Germany Final prothesis: MDT Hans-Joachim Lotz Munich, Germany _Information on patient and treatment The male patient, aged 59, was looking for a new fixed restoration for his maxilla. His case history showed no general disease. The patient had been fit- ted with telescopic model casting prostheses in the maxilla and mandible. Due to the periodontally insufficient anterior residual teeth in the maxilla (teeth 11, 12, 21, 22), the prosthesis could no longer be supported. After loosingtheresidualteeth,thepatientwantedafixed implant-based restoration of the maxilla. The residual teeth of the mandible showed the following findings: tooth 48 was impacted and dis- placed, tooth 45 showed mobility grade 3 and was periodontallyinsufficient.Theanteriorresidualteeth 33–43 presented with increased probing depths on the canine teeth and increased mobility (grade 2). The treatment strategy for the maxilla included as a first step a conservative periodontal therapy of the anterior residual teeth for strategic preservation and fixation of the existing prosthesis until implant insertion. Afterwards, the residual teeth were removed and a bilateral sinus floor augmentation was performed in a two-stage procedure. Following a 3-D planning, eight endosseous implants were inserted with the CAMLOG® Guide System in a flapless procedure, and the prosthetic restoration was realized using a tele- scopicbridge.Inthemandible,tooth45wasremoved whiletheotherteethweretreatedwithconservative periodontal therapy. The mandibular posterior teeth were replaced and realigned. Teeth 43–33 received reveneering of the removable denture. _Conclusions The original goal of the prosthetic reconstruction was a fixed bridge restoration. Due to the hygienic and functional training phase with the long-term temporary appliance, the patient decided for a re- movable bridge. The accuracy and simplicity with which the implants can be inserted in prosthetically correct or anatomically difficult situations is increased significantly by virtual 3-D implant planning in the cone-beam CT or CT in combination with the guided implant bed preparation and implant insertion. Im- plant therapy is thus facilitated. The drilling sequence in the CAMLOG® Guide System is different from other systems. While in a conventional drilling sequence the pilot drill is advanced to the final implant length, the drilling sequence guided by the CAMLOG Guide first starts with the shorter pilot drill (length 6 mm). So that all drills are guided by the sleeve geometry from the start,thedrillingsequenceI performedinsuccession from the 9 mm drill to the 11 mm drill and finally I 13 Full arch reconstruction of theedentulous maxilla Author_Claudio Cacaci, DMD Using the CAMLOG Guide System Prosthetics Fig. 1 Fig. 2