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implants_international magazine of oral implantology No. 2, 2016

| case report 28 implants 2 2016 The surface texture and translucency of the ce- ramics compared to the plastic mock-up surprised the patient and increased his anticipation for the finished work (Fig. 5a & b). After tightening the abutment with a torque wrench to 20 N/cm, both the maxillary and the mandibular bridges were placed into their end position without any tension. Even after the use of pin registration, the bite is un- usual for the patient and should be guided by the practitioner. Only after the patient independently reproducible has found the "new" bite, the occlusal examination by Shimstock film (Coltène®) can take place. Deflective occlusal contacts can be removed withadentaldrillunder­watercooling.Biteregistra- tion serves as visual check for all uniform occlusal contacts. The profile without and with bridges is shown in ­figure 6a. It is plain to see how the upper lip seems voluminous, caused by lip support through the max- illary anterior teeth. At the ceramic try-in, oral hy- giene was practised together with the patient using interdental brushes (TePe®). Close gap areas were identified interdental or between the ceramic and gingiva and expanded in the laboratory. It is always important to ensure that the basis of the dentures is designedconvexlybythedentaltechnicianasrepre- sented in figure 6b by the bridge of another patient. Thehassle-freeoralhygienemustbeensured,specif- ically for older patients with partly limited motor skills. Completion Already one day after bisque ceramic try-in, the bridges were finished and inserted (Figs. 7a-c). After removal of gingiva formers, the gum was inflamma- tion-free. The inner edge of the implant was filled with CHX gel and screwed in the abutments with 30 N/cm according to the manufacturer's recom- mendations. Due to the multiple transmitting of the abutments in the previous steps, we used new abut- ment screws for the final screw, the abutments were cleaned with alcohol and sealed with plastic pellets andCavit.Thefitofthebridgeswascontrolledagain. Thestaticanddynamicocclusionwasbilaterallysuf- ficientintheposteriorarea.Frontandcanineshadno static occlusion. The all-ceramic upper and lower bridges were cemented with temp bond NE (Kerr™). Studiesprovethegoodsealingandgoodbiocompat- ibility of zinc-oxide non-Eugenol cements and rec- ommend it for implant crowns and compounds.5 The number of abutments did not give rise to fearing in- dependentlooseningoftheprosthetic.However,the option of removing the bridges is reasonable for cleaning or reworking reasons. Tooth size and tooth shape were in harmony with the facial appearance (Fig.8).Thepatientisveryhappywiththefinalresult. Then, once again, oral hygiene by using interdental Fig. 6a Fig. 6b Fig. 7a Fig. 7b Fig. 7c Fig. 6a: Profile of the left side with- out and the right side with bridges. Fig. 6b: Convex basis of the bridge. Fig. 7a: Final mandibular and maxillary bridges ready for the patient. Fig. 7b: Maxillary bridge in vivo. Fig. 7c: Mandibular bridge in vivo. 22016

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