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implants - international magazine of oral implantology

case report I I 21implants2_2014 Fig. 5_Maxilla: Extracted canine and explanted implants. Figs. 6a & b_Mandible: An implant is explanted, the remaining implant is cut and left in situ. _Initial examination The patient, a healthy non-smoker, presents with anterior residual dentition (Figs. 1 & 2). He wishestohaveimprovedoralhealthandincreased stability of his prosthesis. At birth he had a cleft palate, which was treated in childhood. All teeth are missing except 13, 33 and 43, 13 and 43 have been endodontically treated. Four years earlier, in the context of a complete prosthetic restoration, implantsweresetinpositions11,21,22and41,42. Upper and lower jaws have received combined fixed and removable solutions. The patient has an open bite in the anterior region, deficiently short incisorsintheupperjawandanunstableocclusion intheposteriorregion.Periodontitisisevidentand found to be serious in the mandible and moderate to severe in the maxilla. Insufficient oral hygiene hasledtoplaqueaccumulationwithresultinggin- givitis. There are pronounced recessions around the implants with exposed machined and partially exposed rough surface areas. Radiologically, peri- implantitis at implants (Bauer screws) 11, 21, 22 is diagnosed (Fig. 3) with suspicion of a foreign body in region 26. Region 13 shows a failing edge of the crown. Mesial lesions in the crown are detected in region 31, 41. _Interactive diagnosis Would you recommend a conventional or im- plant-supported solution for this patient? Or would you opt for root caps in the lower jaw? View the findings of this complex case in detail online. Compose your own prognosis for each tooth with just a few mouse clicks and create your own treat- ment plan with the help of the digital dental chart. Then compare your plan with those of other users aswellaswiththeactualtreatmentchoiceanddis- cuss it in the forum. _Treatment The patient is supplied with a removable pros- thesis, supported by four implants in the maxilla and two root caps in the mandible. a)Hygienephase After taking the impressions, the vertical di- mensioninthewax-upisraised(Fig.4).Inthemax- illa, the bridge is removed and implants are ex- planted, tooth 13 is extracted due to a major loss of substance (Fig. 5). Implant 31 is explanted while implant 41 is treated by implantoplasty whereby the coronal aspect is removed (Fig. 6). An explan- tation would endanger the preservation of tooth 43, due to its location. For this reason, the en- dosseous portion is left below the cortical bone level. The patient is immediately supplied with a temporary prosthesis. To select the optimal aes- thetic tooth shape, two alternative setups for the maxilla are created. b)Surgicalphase Implant restorations in the maxilla are per- formed using computer-assisted navigation (Figs. 7-9). The lacking keratinised mucosa is recon- structedinthemaxillawithapalatalgraftandaro- Fig. 4b Fig. 5 Fig. 6a Fig. 6b

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