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Dental Tribune Middle East & Africa Edition

7Dental Tribune Middle East & Africa Edition | July - August 2013 MEDIA CME ting nerve injury. Implant is placed in an underprepared surgical site to increase primary stability. Fig. 10a and 10b Anterior implants are axially inserted in position of la- teral incisors. Fig. 11 Occlusal view of mandibular implants with abutments. Fig. 12 Provisional acrylic prosthesis containing ten teeth were delivered three hours after the surgery Fig. 13a and 13b Full occlusal con- tacts are limited between canines with no lateral excursions Fig. 14 Verification of passive fit of ti- tanium CAD/CAM frameworks Fig. 15a and 15b Final prosthesis will be realized with titanium CAD/CAM framework with nano-hybrid com- posite teeth and using the IvoBase ® Injector. Fig. 16a and 16b Final bridges contai- ning 12 teeth Fig. 17a and 17b Occlusal view of fi- nal prosthesis with limited posterior cantilevers Fig. 18 Lateral view of patient’s smile with the final restorations Fig. 19 Panoramic radiograph after one year of loading showing implants distribution and bone level mainte- nance. References 1. Brånemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O, Ohman A. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year peri- od. Scand J Plast Reconstr Surg Suppl. 1977;16:1-132. 2. Branemark PI, Svensson B, van Steenberghe D. Ten-year survival rates of fixed prostheses on four or six im- plants ad modum Branemark in full edentulism. Clin Oral Implants Res 1995; 6: 227-231. 3. Adell R, Eriksson B, Lekholm U, Bra- nemark PI, Jemt T. Long-term follow- up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990; 5: 347-359. 4. Ekelund JA, Lindquist LW, Carlsson GE, Jemt T. Implant treatment in the edentulous mandible: a prospective study on Branemark system implants over more than 20 years. Int J Prostho- dont 2003; 16: 602-608. 5..Esposito M, Grusovin MG, Achille H, Coulthard P, Worthington HV. In- terventions for replacing missing teeth: different times for loading dental im- plants. Cochrane Database Syst Rev 2009: CD003878. Full list of references is available from the author. Legends Fig. 1 This 62-years old patient pre- sented with a clear chief complain: “improve my smile with a fixed resto- ration” Fig. 2a e 2b Intra-oral view showed few remaining teeth in the upper jaw and residual roots on the mandible. Partial removable prosthesis did not provided comfort during mastication and esthetic appearance anymore Fig. 3a e 3b Occlusal view of both arches with an adequate amount of keratinized gingiva Fig. 4 Panoramic x-ray evidenced bone loss in both arches due to chro- nic generalized periodontitis, with horizontal resorption and endo-perio lesions in the mandible. The extensive sinus pneumatization did not allow posterior implants placement without a preliminary sinus augmentation procedure. Fig. 5a and 5b Note the inclination of posterior surgical site compared to the anterior one. Thanks to the incli- nation, the posterior implant can be placed following the anterior sinus wall, getting an high level of primary stability. Fig. 6 Occlusal view showing implants distribution along the anterior maxil- la. All implants have been placed with a 50 Newton torque. 30 degrees abut- ments are positioned in the posterior implants to correct their inclination, while 17 degrees abutments are scre- wed on the anterior fixtures for a fa- vourable emergence of the prosthetic screw on the palatal side. Fig. 7 Post-extraction gaps were filled with autogenous bone before flap closure. The flap is sutured in a way to create a minimum 2 mm collar of keratinized gingiva all around every abutment. This peri-implant seal will be very important for the long-term maintenance of the entire rehabilita- tion. Fig. 8 Four verification pins evidenced the direction of surgical sites and the inclination of posterior osteotomies. Fig. 9a and 9b After isolation of men- tal nerve and verification of a possible anterior loop, the preparation of the surgical site is conducted with a me- sio-distal 30 degrees inclination, try- ing to engage the bone area anterior to the mental foramen without crea- mCME SELF INSTRUCTION PROGRAM CAPP with Dental Tribune with its mCME- Self Instruction Program gives you the opportunity to have a quick and easy way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership: Take membership for one year by subscription for the newspaper: 600 AED Take article with one newspaper subscription: 100 AED per issue. After the payment, you will receive your membership number and will be able to start the program. Completion of mCME • mCME participants are required to read a continuing medical education (CME) article in each issue. • Each article offers 2 CME Credit and followed by quiz questioner, which is available in http://www.cappmea.com/mCME/questionnaires.html. • Each quiz has to be return to events@cappmea.com or fax to: +971436868883 in three months form the publication date • A minimum passing score of 80% must be achieved in order to claim credit • Not more then two answered questions can be submitted in the same time • Validity of the article – three months • Validity of the subscription – one year • Collection of Credit hours: you will receive the summary report with Certificate maximum one mouth after expire date of your membership. For single subscription Certificate and summery report will be send one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available in www.cappmea.com after the publication.For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE WRITERS FIND THE CONTACT DETAIL AT THE END OF EACH ARTICLE. Fig. 10b Fig. 13a Fig. 11 Fig. 13b Fig. 12 Fig. 17b Fig. 17a Fig. 19 Fig. 18 Fig. 15a Fig. 16b Fig. 15b Fig. 14 Fig. 16a Dr. Enrico L. Agliardi obtained his Doctorate in Medicine from the University of Mi- lano (Italy) and he specialized in Maxillofacial surgery and Orthodontics from the same university. Contact e-mail:info@studioagliardi.it Contact Information Dr. Davide Romeo graduated in den- tistry at the Uni- versity of Milano, Italy. He received his PhD in new Techniques in Oral Prostheses and Re- habilitation from the same university and he attended the Full time Advanced Program in Periodontics at New York University. 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