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implants international magazine of oral implantology

I case report Fig. 34_Combination of Locator® abutments and prefabricated conical crowns for better stabilisation. Fig. 35_Remanufactured mandibular denture. causingpain.Later,twomoreimplantswereplacedan- teriorbecauseofthepatient'srequestforabetterstabi- lizationofhisprosthesis.However,theconstructionon fourimplantswithLocator®attachmentsbroughtonly a little improvement. Still, the patient was not 100 per cent satisfied, even though the prosthesis was under- linedandperfectlyfittingthejaw.Later,toeliminatethe tilting movements in the distal jaw area during masti- cation,twoLocators®werereplacedbyaprefabricated conecrownsystemwithPEEKsecondaryparts(Fig.34). The immediate stable position and the perfect fit of the mandibular denture were amazing. Finally, the pa- tient got the desired result, which was within his per- sonalbudget(Fig.35). _Discussion Inrecentyears,avarietyofproposalsforaffordable dental implant solutions for the patient are made ac- cording to Held. If one earlier estimated that four im- plants are necessary for a stable construction in the mandible, we are confronted with concepts varying from All-on-4 ® (Paolo Malo) to "All-on-One" (“Better onethannone”)e.g.amulticentrestudybytheUniver- sityofKiel,Prof.DrMatthiasKern.Theaimofthestudy is to provide more and more patients with a cheap and simple reconstruction in limited indications such as a very strong distal atrophy of the mandible. In general, money-savingreducedimplantsolutionshavethedis- advantagethatthelossofasingleimplantalreadyleads to a complete redesign and start from the beginning. Thishastobeconsideredduringthecompleteplanning process. A construction of two implants only with the use of pre-fabricated parts is—at least in the lower jaw —agoodcompromisebetweenaminimalsolution(one implant) with a very restricted indication and an only moderatestabilisationandprostheticcosteffectiveso- lutionsthatarebasedonatleastfourimplants.Thenew high-performancepolymerPEEKoffersincombination with prefabricated conical crowns many ways espe- cially with the use of CAD/CAM technology to expand theprostheticrangeonalow-costbasis.Thecorrosion phenomena when using non precious metals/Eco gold canbeavoided. _Conclusion The bar prosthetic construction in the mandible propagated by Ledermann (1979) is currently the only scientificallyvalidatedindication.Everyotherdescribed technique still requires further clinical testing and sci- entificevidenceoftheirsuitability. The here described treatment option should com- binetheadvantagesofahigh-qualityimplantrestora- tionwiththeadvantagesoflow-costsimplefabrication. The use of prefabricated components and the use of a new cost economical material enable well-fitting stable constructions, especially in cases of advanced mandibular atrophy. New indications like cement and screwlessfixedsolutionsareofspecialinterestandvery challenging. Ceramic veneers can be fused to the sec- ondary parts also in cases of removable bridges and avoidchipping. New materials in the implant prosthetics will con- tinue to offer new additional possibilities. Here, the imaginationofcolleaguesforfurtherdevelopmentisal- most not limited. The use of ceramic veneers fusing to thesecondarypartsinthefrontareaisrisky(chipping). Thereisstillmuchtodo.Let'sdoit!_ Editorial note: A list of references is available from the publisher. 34 I implants3_2014 Dr Rolf Vollmer Nassauer Str.1 57537Wissen,Germany info.vollmer@t-online.de Zahntechnik Michael Anger Drususstr.8–9 53424 Remagen,Germany info@ma-fraeszentrum.de _contact implants Fig. 34 Fig. 35

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