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ePaper created 2016-01-07, 12:59:38 | version 1.38.0
I case report Figs. 9a & b_a) Fabricated customised abutment; b) try-in of the abutment in the restoration. Figs. 10a–c_a & b) Abutment mounted on the implant; c) panoramic radiograph of custom-made abutment #13 in place. Figs. 11a & b_Denture in place; a) close-up; b) anterior view. was restored with a removable teeth-implant sup- ported, palatal free bridge (Figs. 1a-d) using double crownsasattachments,aspreviouslydescribed.2-4 Noimplantswereplacedinregio#16and#26,since the patient decided against performing sinus lift pro- cedures and the remaining bone height was inade- quate to allow implant placement. Furthermore, the patient did not agree to extraction of teeth #13 and #23. Therefore, the final restoration had to be sup- ported by four implants (#14, #11, #21, #24; 4.1 × 10 mm, RN, Straumann, Basel, Switzerland) and two natural teeth (#13, #23) with cantilevers in the areas #15–16 and #25–26 (Figs. 2a–d). Customised implant abutments (torqued to 35 Ncm) and gold copings placedonnaturalteeth#13and#23servedasprimary telescopes (Fig. 2c). Electroformed pure gold copings with a thickness of 0.25 mm (AGC Galvanogold, Wieland, Pforzheim, Germany), fixated in the super- structure with a self-curing copolymer cement (AGC Cem,Wieland,Pforzheim,Germany),aspreviouslyde- scribedwereusedassecondarytelescopes.5, 6 Themetal frameworkwasmilledfromatitan5alloy(ZENOTECTi Disc; Wieland) and covered with micro-ceramic com- posite(Ceramage,SHOFU,Ratingen,Germany).Thepa- tient was put on a three-months maintenance sched- ule. Six years after implant and prosthetic treatment, the patient reported to the office. Tooth #13 had been fracturedinacaraccident.Herefusedanynewrestora- tionandinsistedonkeepingtheexistingone.Thus,im- plantplacementinposition#13wasplanned.Thefrac- tured tooth #13 was extracted. The maxillary denture wasinsertedandabiteregistrationincentralocclusion was performed using self-curing acrylic resin (pattern resin; GC, Alsip, USA). An impression (Impregum; 3M ESPE, Neuss, Germany) of the maxilla was taken with the denture in place. The denture was removed fromthepatient’smouthtogetherwiththeimpression (Fig. 3a). This allowed for the fabrication of a cast with anexactduplicationoftheabutments(Fig.3b). The casts were placed in an articulator using the denture as a guide to achieve correct occlusion (Fig. 4a). A temporary fixed partial denture (from #14 to #24 with #15 and #25 candilevers) from coloured polymethyl methacrylate (PMMA; Zenotec; Wieland, Pforzheim,Germany)wasmilledbasedonascanofthe maxillacast,andwasadheredontheabutmentsusing 16 I implants4_2015 Fig. 10a Fig. 10b Fig. 10c Fig. 9bFig. 9a Fig. 11a Fig. 11b