implants international magazine of oral implantology

I research 10 I implants2_2012 frameworks. Thus, any bar fabricated through an impression or cast technique cannot be truly pas- sive.6–8 A clinical case will be presented below in or- der to demonstrate the direct chair-side method andtheuseoftheSFI-Barontwoimplantstorestore an edentulous mandible. In addition, the main points for use with the indirect method will be out- lined. _Case presentation In 2006, a 60-year-old female patient initially presented, complaining of an ill-fitting lower den- ture. The patient had worn a conventional com- plete mandibular denture for over 20 years, op- posing a metal-based maxillary removable partial denture. The patient had visited a denturist on several occasions to try to improve the situation. After multiple relining procedures, the patient de- cided to seek expert help. An OPG radiograph re- vealedaseverelyresorbedmandiblethatclinically presented as a classic bowl-shaped deficiency (Figs. 9a–c). Radiographic examination revealed there was adequate bone volume in the anterior regionfortheplacementofdentalimplants.How- ever, a fixed solution would only have provided a shortened dental arch, as the mental foramen had become more mesial owing to bone resorption. Placingimplantsdistaltothementalforamenwas not an option, owing to the proximity of the infe- rior dental nerve and lack of bone height. The pa- tient was not keen to have any nerve reposition- ing or complex bone grafting. Another important factor negating the fixed solution was the size of the volume defect. This would have been difficult both to correct and to maintain and would have produced a poor aesthetic result. The additional bulkofdentureflangesallowedproperfacialsup- port. After discussing all the relevant issues, the pa- tient decided that the removable overdenture re- tained with two implants was the best and least complicated treatment option for her. The upper denture was not an issue for the patient, as it was retentiveandstable.Inordertolimitcosts,theup- per denture was not replaced. A surgical guide was fabricated after the vertical dimension, aes- thetic and phonetic parameters had been cor- rected in the wax denture try-in. Two 4.1 mm RN connection dental implants (Straumann), each 8 mm in length, were placed in sites #32 and #42 (Figs.7a&9b).Thesewereallowedtointegratefor threemonthspriortotheprovisionofaball-abut- ment-retained overdenture. This denture func- tioned without surgical or prosthetic issues for a five-year period. Unfortunately, the patient revis- ited her denturist and complications arose after an attempted intra-oral relining procedure. On examination,itwasdeterminedthattheballabut- ments were damaged and needed to be replaced. The female housings needed to be replaced, as they were no longer seated properly on the ball abutments. The patient was then given the option of hav- ing either another ball-abutment-retained over- Fig. 8 Fig. 9a Fig. 9b Fig. 9c Fig. 10