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ePaper created 2015-03-07, 18:13:20 | version 1.33.01
case report _ full-arch restoration I _Temporary bridge and immediate loading It was agreed with the patient that the implants would be immediately loaded, provided that good initial stability was obtained. The temporary remov- ableprosthesiswouldbewornforalimitedperiod.For- tunately,adequatestabilitywasachieved,allowingfor immediate loading. Each implant (except #27) was torqued to 35 Ncm or more. On the same day, an im- pression was made using the pick-up technique, with a previously prepared impression tray. First, the final straight conical abutments were hand tightened into the implants using a torque of 15 Ncm. They were in- tended to accommodate the screw-retained provi- sionalandthenthefinalscrew-retainedprosthesis. The Axiom PX implant system offers two major advantages: platform switching and indexing trilobe Morse taper connection. The latter greatly facilitates abutmentplacement.Atightstableconnectionguar- antees integrity of the soft tissue (Fig. 8). In the laboratory, the master model with the embedded analogue was used to fabricate a master plaster cast. A high-rigidity cobalt–chromium and resin temporary bridge was fabricated, tried in, and transferredtothepatient’smouth48hoursafterthe implants had been placed. This provisional device would serve as an external fixator during osseo- integration of the implants. A control radiograph was taken to confirm the passive fit of the framework. The temporary bridge washandtightenedtoatorqueof10Ncm.Theocclu- sion was accurately adjusted (Figs. 7a-c). The patient wore the temporary bridge for six months. During that period, a number of parameters were evaluated, includingocclusion,osseointegrationstatus,oralhy- giene, mastication, phonetics, aesthetics and lip sup- port. The temporary bridge should be rigid (frame- work) and easily removable (screw fixation). Site #27 healed uneventfully, protected as it was from me- chanical stress. Fig. 10_A wax-up of the framework. Figs. 11a–d_CAD of the model. Figs. 12a–c_Machining from a titanium block. I 23cone beam1_2015 Fig. 11dFig. 11c Fig. 11bFig. 11a Fig. 12cFig. 12a Fig. 12b Fig. 10