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ePaper created 2014-08-26, 21:44:32 | version 1.30.01
22 I I case report _ full-arch restoration acrylic resin and commercially available teeth for visibilityofthedesiredtoothlocationintheCTimages (Fig. 3). The CT examination showed adequate bone volume in the grafted posterior regions and an even sinus floor with homogeneous allografted areas. The dome-like shape of the vestibulo-lingual cross- sections was indicative of the absence of material leakage into the maxillary sinuses (Fig. 5a). _Osteogenic activation I performed osteogenic activa- tion of the processed maxgraft bone used for sinus lift using the technique described by Scortecci. A trans-parietal approach was used for insertion of the Bone Matrix Osteotensor (Victory) after a minimally invasive flapless protocol (Fig. 4). Endosteal stimulation re- sults in osteogenic activation and allows evaluation of the mechanical strength of the grafted areas by probing. Owing to this simple and minimally invasive technique, theinitialqualityofthefuturerecipientbone siteiseasilyassessed.Thesetechniqueshave been successfully used in orthopaedics for ten years. In view of the excellent response toosteogenicactivation,itwasdecidedthat implants would be placed 45 days later. _Treatment planning The case was planned in the SIMPLANT (DENTSPLY Implants) treatment planning software. The scan prosthesis is critical for determination of the correct position and axial alignment of the implants; visualisation of the emergence profile; and determination of the size, position and axial alignment of the abutments. Furthermore, it allows optimal use of the available bone height. At this stage, special attention should be paid to 3-D positioning of the implants and par- ticularly to the emergence profile in order to facili- tate the fabrication process of the final restora- tion. Straight or angled conical abutments are now clearlyvisibleonthevestibulo-lingualcross-sections. Ten Axiom PX implants (Anthogyr) were planned for a maxillary screw-retained bridge restoration (Figs. 5a-c). _Implant placement Implantplacementwasperformedunder local anaesthesia using the case-specific surgical guide. For this patient, I used a spe- cific implant design (Axiom PX, Anthogyr) withsymmetricaldouble-leadthreads(self- drilling and self-tapping) and a reverse con- icalneck(Fig.6).Itsuniquedesign,combined with a special drilling protocol, promotes bonecondensationeveninsoftbone,ensur- ingexcellentinitialfixation.TheBCP(bipha- sic calcium phosphate) sandblasting tech- niqueyieldsanimplantsurfacewithsuperior osteoconductive properties that positively influence the development of osteoblastic cells in the early stage of osseointegration. A flapless technique was used for implant placement. The flapless technique has defi- nite advantages: preservation of the subpe- riosteal blood vessels, and improved patient comfort owing to a shorter operating time and simple post-operative care. Fig. 6_Axiom PX implant (Anthogyr). Fig. 7a_Panoramic radiograph showing the temporary bridge placed 48 hours earlier. Figs. 7b & c_The high-rigidity temporary bridge made of cobalt–chromium and resin. CAD/CAM 3_2014 Fig. 7b Fig. 7c Fig. 6 Fig. 7a Fig. 9c Fig. 9d Fig. 9a Fig. 8 Fig. 9b CAD0314_20-25_Marcelat 22.08.14 14:22 Seite 3