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CAD/CAM - international magazine of digital dentistry

Introduction Implant treatment has evolved into a reliable modal- ity for the replacement of missing teeth. Although rare, complications may occur, and some uncertainty surrounds the treatment of some of these events, especially when restorations are supported by a combinationofnaturalteethandimplants.1 Oftenthe fabricationofanentirelynewrestorationisnecessary if one or several of the natural teeth need to be re- moved. Here, we report two cases in which a natural tooth abutment of a restoration supported by im- plants and natural teeth fractured. We describe the technique used to replace the fractured tooth with an implant, which allowed the re-use of the existing restoration. Cases Case 1 The patient was a 62-year-old male non-smoker in good general health, who was taking no medication and had received implant treatment at the author’s office six years before developing the complications described in this article. The mandible was restored with fixed crowns and implant retained bridges. The maxillawasrestoredwitharemovableteeth-implant supported, palatal free bridge (Figs. 1a–d) using dou- blecrownsasattachments,aspreviouslydescribed.2–4 No implants were placed in regio #16 and #26, since the patient decided against performing sinus lift procedures and the remaining bone height was in- adequate to allow implant placement. Furthermore, the patient did not agree to extraction of teeth #13 and #23. Therefore, the final restoration had to be supportedbyfourimplants(#14,#11,#21,#24;4.1× 10 mm, RN, Straumann, Basel, Switzerland) and two natural teeth (#13, #23) with cantilevers in the areas #15–16and#25–26(Figs.2a–d).Customisedimplant abutments (torqued to 35 Ncm) and gold copings placed on natural teeth #13 and #23 served as pri- mary telescopes (Fig. 2c). Electroformed pure gold copings with a thickness of 0.25 mm (AGC Galvano- gold, Wieland, Pforzheim, Germany), fixated in the superstructure with a self-curing copolymer cement (AGC Cem, Wieland, Pforzheim, Germany), as previ- ouslydescribedwereusedassecondarytelescopes.5,6 The metal framework was milled from a titan 5 alloy (ZENOTEC Ti Disc; Wieland) and covered with mi- cro-ceramiccomposite(Ceramage,SHOFU,Ratingen, Germany). The patient was put on a three-months maintenance schedule. Six years after implant and prosthetic treatment, the patient reported to the of- fice. Tooth #13 had been fractured in a car accident. Herefusedanynewrestorationandinsistedonkeep- ingtheexistingone.Thus,implantplacementinposi- tion #13 was planned. The fractured tooth #13 was | case report abutment fracture 14 CAD/CAM 2 2016 Abutment fracture in a bridge supported by natural teeth and implants Authors: Dr Gregory-George Zafiropoulos, Dr Giorgio Deli & Dr Rainer Valentin, Germany/Italy Figs. 1a–d: Casts placed in the articulator; a) right side, restoration not in place; b) left side, restoration not in place; c) anterior view, restoration in place; d) left side with restoration in place. Fig. 1a Fig. 1b Fig. 1c Fig. 1d 22016

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