implants - international magazine of oral implantology

Impressionwastakeninthemaxillaforthefabricationofanewdenture.Anim- pression was taken from the mandible using an alginate material with the partial removable denture in situ, so that the dental laboratory could put new denture teeth in occlusion with the maxillary denture (Fig. 7). A duplicate of the new max- illary denture (DentDu) was fabricated using clear methyl-methacrylate (Paladur; Heraeus,Hanau,Germany)andkeptforlateruse(Fig.8).Thecustomisedgoldabut- mentfromimplant#14wasreplacedthroughalocatorandlocator smatriceswere embedded in the basis of both the denture and the DentDu (Fig. 9). Four weeks after socket augmentation and preservation, membranes were re- moved (Figs. 10a & b). Four implants were placed in the mandible (#36, 35, 32, 42; Table 1) and the periodontal pocket #47 was regenerated using DBX and a re- sorbable collagen membrane (BoneProtect, Dentegris, Duisburg, Germany). Addi- tionally, FPDs #34, 33, 44-47 were removed and the natural teeth abutments were prepared. Impression of the mandibular teeth abutments was taken using a poly- ether material (Impregum Penta Soft, 3M ESPE) and a master cast was made. After that, chairside temporary FPDs for the natural teeth abutments in the mandible were fabicated, using a self-curing composite material (Structur 2, VOCO, Cux- haven, Germany). The dental technician fabricated: a) metal-reinforced long term provisional FPDs and b) final metal-ceramic FPDs (which were kept for later). On the next day, the metal-reinforced temporary FPDs were fixed using a pro- visionalcement(TempBond,Kerr,Bioggio,Switzerland)andbothmaxillarydenture and DentDu were fitted and the occlusion was controlled (Fig. 11). Theanalysisofthearticulatedcastsshowedlargeverticaldistancesbetweenthe occlusal plane and the maxillary alveolar crest: 1.7 cm in the left premolar/molar area, 1.4 cm in the right premolar/molar area, 1.5 cm in the anterior area (Fig. 12). Therefore, a removable restoration was suggested. Six months after augmentation in the maxilla, the DentDu were used as plan- ning templates for assigning the implant positions (Fig. 13). Six implants were placed and implant #14 was also kept (Table 1, Fig. 14). Fourmonthsafterimplantplacement,theimplantswererecoveredandsystem- specific healing caps were mounted. An open-tray impression was taken using a polyether material (Impregum Penta Soft, 3M ESPE) and the working cast was fab- ricated. DentDu supported by the locator was used for recording the maxillo-mandibu- lar relationsship. A bite registration was taken with a resin (pattern resin®, GC, Al- spir, IL, USA) and DentDu was placed on the cast and mounted in the articulator (Fig. 15). Implant abutments were fabricated using system specific customisable abut- ments (PTIR, Dentegris, Duisburg, Germany) casted with a CoCrMo alloy (Ankatit Laser, Ankatit-Anka Guss, Waldaschaff, Germany) and served as primary tele- scopes. Electroformed gold copings (0.25 mm thick; AGC Galvanogold, Au>99.9%, Wieland Dental, Pforzheim, Germany) were also fabricated over the customised implant abutments. The DentDu, the customized abutments and the gold copings were used for scanning, creating and milling of a titan framework (Zenotec Ti, Wieland Dental, Pforzheim, Germany). For veneering of the framework, a micro- ceramic composite was used (Ceramage, SHOFU Dental, Ratingen, Germany). After veneering, the abutments were mounted with 35 Ncm (Fig. 16). The elec- troformed copings were placed on the abutments (Fig. 17) and fixed in the super- construction using a self-curing cement (AGC Cem, Wieland Dental, Pforzheim, Germany). bionicstickygranules Degradable Solutions AG A Company of the Sunstar Group Wagistrasse 23 CH-8952 Schlieren/Zurich www.easy-graft.com Ingenious: Simple handling and accelerated osteocon- duction for long-term volume preservation. easy-graft® CRYSTAL AD