implants - international magazine of oral implantology

I overview whether or not an implantation is possible. With the proper planning software, actual preparations can be made virtually. For instance, in our clinic we use Co-Diagnostix. Case presentation A 44-year-old female patient suffered from peri- odontitisprofundaandcametoourclinicwiththespe- cific wish of not wanting dentures under any circum- stances—even as a temporary solution. All her teeth were extremely loose. Nutrition for her was limited to softfoods. The plaque control report of our clinical examina- tion showed optimal oral hygiene. The last profes- sionalcleaninghadtakenplacesixmonthsago.Anad- ditional professional cleaning was not performed sincenoimprovementscouldbeexpectedandnocon- cretionswouldenterthemouthduringextractions. Concretionswerefoundsubgingivallyandapprox- imally, which the patient could not remove in spite of all her best oral hygiene efforts because they were lo- catedtoodeeplytobereachedbyatoothbrushorden- tal floss. Looseness of her teeth was between 2 and 3, but mostly at 3. Bone loss had taken place equally in theupperandlowerjaw. Further diagnostic examinations were conducted via digital tomography. Digital tomography precisely illustrates available space, nerve placements and to- pography of the jaw cavity. With this examination methoditcouldbedeterminedthatthepatient’steeth couldnotbesaved. Use of the Co-Diagnostix software facilitated de- tailedplanningforthepositioningoftheimplantsand thenecessarysinusliftoftherightupperjaw.Highest precision planning was made possible by the three- dimensionalimagesandprecisedatagainedbytheuse ofdigitalvolumetomographyinpre-operativeexam- inations. Diagnostic findings were confirmed during sur- gery: Natural fastening of the teeth in the upper and lower jaw was no longer possible. The teeth were ex- tracted. After the extraction of teeth in the upper jaw, four implantsweresetatanangleof17degrees—regio14, 12,22,24.Inregio26,oneimplantwasinsertedata35 degree angle. Afterwards we began a sinus lift proce- dure in the right upper jaw. Through a window in the facial bone wall we detached and lifted the Schneider membrane from the sinus floor, the mesial and distal wallsofthejawcavity.Theresultingspacegaveusthe opportunityofanchoringendosseousimplantsbyfill- 28 I implants3_2013 Figs. 3a & b_Co-Diagnostix Planning Software: Showing where to place implants. Figs. 4a–d_Loss of tooth attachment shown during surgery. Fig. 2e Fig. 3a Fig. 3b Fig. 4a Fig. 4b Fig. 4c Fig. 4d