cone beam international magazine of cone beam dentistry

I case report _ dental implantology The surgeons judged that the two terminal implants could not sustain immediate loading, as the bone in those areas was too soft (Fig. 54). Bone graft material (Bio-Oss, Geistlich) was filled in around those two implants and covered with a GORE-TEX Regenerative Membrane (Gore Medical; Fig. 55). Cover screws were then placed and the areas were sutured so that the Balance Base Abutments were barely visible under the gingiva (Figs. 56 & 57). According to the original CBCT-derived plan, the remaining six implants had bone in sufficient volume and density to enable immediate loading, and the connection to the two terminal implants would help improve healing. The ANKYLOS retention copings were positioned and tightened (Fig. 58). The surgeons opted to insert the CAM-fabricated PMMA tem- porary restoration so that the patient would not have to go home without any maxillary teeth (Figs. 59 & 60). It was decided to insert the metal- strengthened long-term temporary restoration the following day. This additional step was neces- sary because the two terminal implants were not immediately loadable and because it was deter- mined that the PMMA restoration would not be able to provide sufficient stability for six implants longterm.Thiswasthefirsttimethatthesurgeons had inserted a previously manufactured tempo- rary restoration for immediate loading. The fit of the PMMA restoration was excellent and the aesthetic appearance was pleasing, even after the extensive surgery. Fig. 56_Sealing both terminal implants with a surgical cover screw. Fig. 57_The stitched gingiva. Fig. 58_Positioning of the ANKYLOS retention coping. Fig. 59_The milled PMMA temporary restoration is inserted. Fig. 60_The aesthetics after this complex operation was pleasing. Fig. 61_The temporary restoration was fixed with composite. Fig. 62_Photopolymerisation. Fig. 63_One day after the operation, the PMMA temporary restoration was exchanged for the temporary bridge with the metal substructure. 22 I cone beam2_2014 Fig. 63 Fig. 62Fig. 61 Fig. 59 Fig. 60 Fig. 56 Fig. 58Fig. 57