implants - international magazine of oral implantology

I case report 26 I implants4_2012 At the same session, the final mandibular FPDs were fixed using an acrylic/urethane based tem- porary cement (Implant Provisional, Alvelogro Inc., Snoqualmie, WA, USA; Figs. 18–22). _Discussion This case report details the treatment of a pa- tient with insufficient maxillary alveolar ridge height caused by generalised advanced peri- odontal disease, as well as by subsequent implant treatment, insufficient implant-prosthetic restoration, failure of maintenance, and develop- ment of periimplantitis. A considerable distance between the occlusal plane of the mandible and alveolar ridge of the maxilla was caused by exten- sive bone resorption. Telescopiccrownshavebeenusedsuccessfully to connect dentures to natural teeth for several decades. Recent clinical data have indicated that the use of telescopic crowns with implant-sup- portedoverdenturescanleadtopredictablelong- term treatment outcomes.7-11 The patient’s ability toremovethesecondarystructurealsofacilitates abutment hygiene, providing an additional peri- odontal advantage for the telescopic crown sys- tem.2,11 Furthermore, the high retention achieved through friction force leads to good mastication and phonetics. Further advantages of treatment with telescopic crowns include (a) maximisation of masticatory-force transmission that are al- ways axial to the abutments; (b) facilitation of ef- fective oral hygiene; (c) ability to position teeth favourably; (d) avoidance of several soft- and hard-tissue augmentative surgeries; (e) achieve- ment of favourable aesthetics, even with severe atrophy of the jawbone, which can be covered by the lip shield; (f) the ability to renew veneering at any time; and (g) stability of the restoration, even when an abutment implant is lost. The main dis- advantages of this type of construction are cost and technical requirements, as well as possible psychologicalburdensexperiencedbythepatient provided with a removable appliance.5,11 The initially delivered denture allowed for the correctionoftheinterocclusalrelationship,tooth shape, colour, and angulation throughout the treatment period. In this way, the patient could become acclimated to the function and aesthet- ics of the denture. By using a duplicate of this denture to take the bite records and as a mount- ing guide, the maxillo-mandibular relationship was recorded and transferred accurately and the aestheticoutcomepreviouslyacceptedbythepa- tient was achieved. Thus, it was not necessary to repeat the usual clinical recordings (e.g., centric relation, occlusal vertical dimension, tooth posi- tion and aesthetics, wax try-in) at the time of fi- nal restoration fabrication.12 Additionally, the combined use of the DentDu andthesiliconkeyallowedfortheselectionofim- Fig. 11_Mandibular temporaries in situ and fitting of the denture duplicate. Fig. 12_Planing casts mounted in the articulator. Fig. 13_Orthopantomograph. Maxilla: after augmentation (sinus, periimplant defect), implant planing. Mandible: after regeneration surgery, temporary restoration. Fig. 14_Maxilla: implant placement. Fig. 15_Mounting of the casts using the denture duplicate. Fig. 16_Customised abutments in situ. Fig. 17_AGCs fiting. Fig. 15 Fig. 16 Fig. 12 Fig. 13 Fig. 14 Fig. 11 Fig. 17