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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
I case report 30 I implants3_2014 Aftertheremovalofthebondedparts,thecomplete partwasresettotheworkingmodel(Figs.18a&b).There were no deviations or tensions detected. In the dental laboratory, the total work now could be completed so thattheintegrationoftheprosthesiswasalreadyatthe nextmeeting(Figs.19a&b). The PEEK abutments "run" or glide on the primaries very good. The prosthesis has a very solid tension-free fit and can still be easily removed by the patient. Pros- thesespressurepointshavenotoccurred. Case3:Fixedorremovableprosthesisonnineimplants— screwingorcementingornoneofboth? Thefemalepatient’sagewas51whenabout14years ago, in the year 2000 she received maxillary and mandibular implants. The wish of the patient at that time was not wearing removable parts in her mouth. Laterinthemaxilla,afixedceramicfusedtometalbridge restorationwasincorporated.Inthelowerjaw,a14unit acrylic bridge metal enforced from one piece was inte- grated. A retrievability was provided as in the anterior region a larger defect was already present. This region was used to stabilise the interim prosthesis with so- calledbicorticalscrews. However,sinceitturnedoutthatafterthehealing thebicorticalscrewswereabsolutelystableandfirmly healed,theywereleftinthejawandincorporatedinto the prosthetic construction. After about ten years, the patient started having problemsatthedistalrightimplantwhichturnedout to be loose and had to be removed (Fig. 20). After a small makeover, the existing bridge was then reinte- grated. The implant failure had likely been caused by the so-calledmedialshift(Fig.21)ofthemandibleandthe cantileverconstruction.Sometimes,thiseffectisalso observedinbridgesinthemandible,rangingfromthe anterior region to the wisdom tooth. Especially when the patient is older and the lower jaw shows a de- crease of density, it comes to this release or dece- menting effect. For this reason, appropriate separa- tionpointsshouldalsobeincludedinthemandibular Figs. 19 a & b_Prosthesis finished and final incorporation. Fig. 20_Situation ten years after full implantation. Loss of one implant in the lower right mandible. Fig. 21_Medial shift by the masticatory muscles. Figs. 22a & b_Original bridge designed for cementation. Signs of wear, discolouration, abrasions and cracks. Fig. 18b Fig. 18c Fig. 19a Fig. 19b Fig. 20 Fig. 22aFig. 21