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implants - international magazine of oral implantology

I case report 24 I implants4_2012 sulting in a large vertical dimension.1-4 This article presents the treatment of such a case. _Case The 55-year-old patient (male, nonsmoker, in good general health) presented for consultation and treatment in our clinic in August 2010. The pa- tient had a three-year-old removable denture (with mid-palatal strap) in the maxilla, supported by four implants using telescopic crowns as at- tachments (Table 1; Figs. 1 & 2). It was shown that the premolars/molars of the maxillary denture were not in occlusion with the mandibular teeth (Figs. 3 & 4). Furthermore, the denture was fabri- cated with a sagittal malposition in the anterior area (Figs. 3 & 4). Around the implants, pockets of 6-10 mm with spontaneous bleeding, swelling of the soft periimplant tissue and pain by palpation were recorded (Fig. 2). A 15-year-old removable partial denture and fixed partial dentures (FPDs) were found in the mandible. The removable partial denture used the following attachments: a) direct retainers (clasps, areas #37 and #43), b) customised gold attach- ment (area #34-33), c) a gold double crown (area #47)(Figs.3&4).Theperiodontaltissueshowedan inflamed gingiva, pockets of a depth of 5-6 mm andadeepverticalbonedefectatthemesialsiteof the tooth #47 (Fig. 2). Treatment Implants #13, 23, and 24 were explanted, the bone defects were cleaned and augmented by us- ing non-resorbable dPTFE membranes (Cytoplast, Regentex GBR-200; Osteogenics Biomedical, Lub- bock, TX, USA) without additional use of any graft- ing materials, as previously described (Fig. 5, Fig. 6).5,6 Flaps were repositioned with interrupted su- tures. Membranes were left partially exposed (Fig. 6).Theimplant#14(incl.abutment)wassavedand used for supporting the maxillary denture. In the same clinical session, sinuses were augmented us- ing a demineralised bovine xenograft (DBX; Com- pactBone B, Dentegris, Duisburg, Germany). In the mandible, the natural teeth were treated byscalingandrootplaningandthecrownmargins were shorted and finished for allowing a better healing of the soft tissue. Tooth #37 was extracted andthesocketwaspreserved/augmentedasabove described. Fig. 7_New interim denture in the maxilla and improved partial denture in the mandible. Fig. 8_Duplicate of the maxillary denture (DentDu). Fig. 9a–b_Locator-matrice(s) embedded in the basis of the denture (a) and of the duplicate (b). Fig. 10a–b_Socket preservation: a: after removal of the membranes, b: soft tissue healing. Table 1_Implant Characteristics Fig. 7 Fig. 8 Fig. 9a Fig. 9b Fig. 10a Fig. 10b Implantats area,Restoration (new/old) Implant Line Diameter x Length (mm) Time (Months) until uncovering Customized Abutments 13 (old) RN #,4,1x10 4 Gold † 14 (old + new) RN #,4,1x10 4 Gold † 23 (old) RN #,4,1x10 4 Gold † 24 (old) RN #,4,1x10 4 Gold † 16 (new) SB *,4.5 x 11.5 4 CrCo ‡ 15 (new) SB *,3.75 x 10 4 CrCo ‡ 12 (new) SB *,3.75 x 10 4 CrCo ‡ 23 (new) SB *,3.75 x 10 4 CrCo ‡ 25 (new) SB *,3.3 x 10 4 CrCo ‡ 26 (new) SB *,4.5 x 10 4 CrCo ‡ RN # = Regulat Neck, Institut Straumann, Basel, Switzerland SB * = Soft Bone, Dentegris, Duisburg, Germany † = Portadur P4, Au 68.50%, Wieland, Pforzheim, Germany ‡ = Ankatit, Anka Guss, Waldaschaff, Germany