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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
bridge restorations. Cantilever constructions should be avoided whenever possible. Over the years, the gingiva of the patient was for whatever reasons much more sensitive and the pa- tienthadgreatfeartolosemoreimplantsinthelower jaw. She wore the existing bridge structure only as a kindofalooseremovablebridge.Sincethedesignwas intended for at least a temporary cementation, it al- ways came to a wear and chipping of the plastic ve- neers,whichcouldnolongerberepaired(Figs.22a&b). Now, in 2014, the patient is 65 years old and a new treatment-plan with three divided bridges for ce- mentation was suggested. However, she refused and insisted to get a part that is removable or to have the oldonerepaired,whichfortechnicalreasonswasnot possible. There were different solutions discussed in- cludingnewprimarytelescopepartsandelectroplat- ingtechniqueforthesecondaryparts.Adecisionwas not made by the patient especially because of cost reasons. The only statement was that she wanted to have something like a removable bridge. After assessments and parallelism measure- ments of the existing models in the dental labora- tory, it turned out that there was also the opportu- nity to design a new restoration with the help of PEEK secondary crowns and a tertiary cast frame- work for acrylic pontics without removing the orig- inal abutments (Fig. 23). The patient agreed on this proposal. First, the PEEK secondary parts, some of which were splinted, were tried in (Figs. 24a–c). The fitting was very good. The model casting reinforcement for the tertiary structure also fitted perfectly (Fig. 25). So thebondingofboth(PEEKandmetalframe)similarto the previous case was done directly into the patient’s mouth (Figs. 26a & b). In this case, a pick-up impres- sion in the double mixing method was manufactured (Fig. 27). The bite was registered over the tertiary structure. The result was a very good matching, stress-free, removable bridge with a pleasant chew- ingcomfortthatmeetstheneedsandexpectationsof the patient (Figs. 28 & 29). I case report Fig. 23_Clinical situation after removing the bridge. Figs. 24a–c_New designed secondary parts made of PEEK; Tertiary structure. Fig. 25_Try-in of the tertiary structure. Figs. 26a & b_Glueing the tertiary structure to the PEEK secondary crowns. 32 I implants3_2014 Fig. 25 Fig. 26bFig. 26a Fig. 24a Fig. 24cFig. 24b Fig. 22b Fig. 23