CAD/CAM international magazine of digital dentistry

I case report _ restoration of edentulous maxilla Fig. 9_Frontal view of the finished superstructure. Fig. 10_The incorporated restoration in the patient’s mouth; excellent translucence of the selected dentition (Genios, DENTSPLY DeTrey). Fig. 11_OPG for the follow-up; stable conditions almost two years after incorporation of the prosthetic restoration. The advantage of the Friadent MP abutments is the transfer of the working level from the implant shoulder—that is, the crestal edge of the bone—to a supracrestal plane. Hence, the apposition of the marginal tissues on the abutment components is not affected by try-ins and other treatment steps. Furthermore, a simple visual check of the bar seat- ing can be made. Figure 2 shows the patient’s con- dition prior to impression making, with inserted FriadentMPabutments.Themodelfabricatedusing the MP analogs and a XiVE TG implant analog was sent to the DENTSPLY Scan Center with the tem- porary construction. The option of displaying and masking various structures, such as the soft tissues, the dental arrangement, the implants and the bar construc- tion, allows a simplified check of the construction proposal (Figs. 4a to 4d). This is adjusted to the practitioner’s preferences as required. Galvanic bar latches are manufactured on the titanium CAD/CAM-fabricated bars, embedded in the open- ings for the slide axles. The tertiary structure is cast from a chrome-cobalt alloy. In order to guarantee a tension-free fit for the supported metal base, this was cemented to the bar latches in the patient’s mouth. The Genios dentition (DENTSPLY DeTrey) was transferred to the manufactured framework (Figs. 5 to 8). The final restoration was adjusted to the pa- tient’s mouth and inserted (Figs. 9 and 10). The dentition showed excellent translucency. On follow- ups 27 months after the implant insertion and 21monthsaftertheincorporation,thetissuecondi- tionswerestable(Fig.11).Thecrestalbonelevelwas still located on the implant shoulder. No resorption was observed. _Conclusion Because of its good primary stability, even in marginal situations, the XiVE implant system is ap- plicable in an augmentation of the maxillary sinus with simultaneous implant placement. Where there is little remaining bone volume, the prerequisite for this is a classic, submerged healing phase without pressure. The option of relocating the connection level to an epigingival level following uncovering reduces the risk of a deterioration of the bone in the region of the implant shoulder due to manipula- tion. CAD/CAM fabrication of the bar constructions markedly improves the fit of these constructions, whichapractitionerwhohasusedthisnewtechnique willimmediatelyrecognize.Togetherwiththeuseof titanium as the component material, the tension reductionrepresentsafurtheradvanceintherepro- ducibleretentionofmarginalbone.Furthermore,the bar construction with latches restores the desired level of security and hence vitality to the patient. Editorial note: A complete list of references is available fromtheauthor. 22 I CAD/CAM 3_2012 Fig. 9 Fig. 10 Fig. 11 Dr Arnd Lohmann got his Licensure in Hamburg, Germany,in 2002 and worked as assistant doctor in Oral and Maxillofacial Surgery from 2002 to 2003.In 2003 he completed his dissertation. He has focused on Oral Implantology since 2003 and completed his Master of Science in Oral Implantology in 2007. He is a member of the German Society of Oral Implantology (Deutsche Gesellschaft fuer Orale Implantologie,DGOI),the GermanAssociation of Dental Implantology (Deutsche Gesellschaft fuer Zahnaertzliche Implantologie,DGZI) and the GermanAssociation of Oral Implantology (Deutsche Gesellschaft fuer Implantologie,DGI). He works in a partnership and medical practice with Dr Rainer Lohmann in Bremen,Germany. Dr Arnd Lohmann,MSc Ostpreußische Str.9 28211 Bremen Germany Tel.:+49 421 443868 mail@zahnarztpraxis-dr-lohmann.de www.zahnarzt-dr-lohmann.de _about the author CAD/CAM