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ePaper created 2015-09-09, 12:07:54 | version 1.38.0
I case report _ implant restorations 28 I CAD/CAM 3_2015 Fig. 11_Three months post-op: frontal anatomical shaping of the jaw, sufficiently thick attached gingiva. Fig. 12_Occlusal view: reconstructed hard and soft tissue, ready for implant insertion. Fig. 13_Two-component sleeve for CT-planning incorporated in the prosthetically correct implant position. Fig. 14_Full length of the Ø 2.2 mm sleeve was utilised initially. Fig. 15_Pilot drilling is deepened through the 4 mm high sleeve section. Fig. 16_Skeletonised implant template creates the largest possible space for the head of the angled handpiece for pilot drilling. Fig. 17_Exposure of jaw bone and removal of two osteosynthesis screws. Fig. 18_Insertion of skeletonised implant template. protect against resorption. The bone augmentation was covered with a resorbable Bio-Gide membrane (Geistlich) cut to size. A periosteal slit allowed maxi- mum mobilisation of the flap which was shifted coronally. Using horizontal mattress sutures it was adaptedtension-freetothewoundedgesandsutured tightly with individual button sutures. Precise wound edge adaptation is a precondition for interference- free wound healing.4-6 The radiographic control image (Fig. 10) shows the fixated bone block in region 21 and the donor site on the Corpus/Ramus mandibulae. The flipper with the shortened plastic tooth was in- serted as temporary restoration (Fig. 11). Only little pressure was to be exerted on the tissue during bone healing.Thisrequiredunderstandingbythepatientand modified(eating)behaviour.Aftertendaysthepatient visitedforacheck-upandremovalofthesutures.Three monthsaftersurgery,thenaturalalveolarboneprofile was stable and with a sufficiently keratinised gingiva (Fig.12).Animpressionofthissituationwastakenand animplanttemplateprepared. The dental technician fabricated a skeletonised template. A two-component sleeve for CT-planning wasincorporatedattheprostheticallycorrectimplant position7, 8 and the plastic reduced as far as possible betweentheadjacentteeth.Thisreductionalsoenables placing of the template during the surgical procedure with mucoperiosteal flaps and provides maximum space for the angled handpiece during preparation of theimplantbed(Figs.13–16). _Implantation Implantation was performed four months after bone augmentation. Following local anaesthesia, a vestibular flap was prepared, the jaw bone exposed andthetwoosteosynthesisscrewsremoved(Fig.17). Pilot drilling was performed with the aid of a drilling template through the two-component CAMLOG sleeve for CT planning (2.2 mm diameter; Fig. 18). All other drilling steps to prepare the implant site for the CAMLOG® SCREW-LINE implant, length 13 mm and diameter 4.3 mm, were performed without a template. Placement of the implant was performed three- dimensionallyfollowingthecriteriafortheanatomic windowaccordingtoGomezandtakingintoaccount the biological conversion processes associated with implantrestorations.Inthispatientcasetheimplant shoulderrested1–2mmbelowthecemento-enamel junction of the adjacent teeth. The implant shoulder wasplacedapproximately2mmpalatinaltotheden- talarchinoro/vestibulardirection.Apicalplacement compensates for differences between the anatomi- cal emergence profile of the crown and the implant diameter. The mesio/distal distance between the outer edge of the implant to the adjacent tooth should be approximately 2 mm (Figs. 19 & 20). The Fig. 14 Fig. 16Fig. 15 Fig. 11 Fig. 13Fig. 12 Fig. 17 Fig. 18