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CAD/CAM - international magazine of digital dentistry

abutment fracture case report | 19CAD/CAM 2 2016 viouslydescribedincase1.Ashortimplant(Endopore 4.1 × 9 mm, Sybron Implant Solutions, Bremen, Germany) was inserted into area #15 (Fig. 13). Four months after implant placement, impressions were taken and a customised gold implant abutment and new secondary telescopic crown were fabricated and integrated into the same position as tooth #15 (Figs. 14and15).Duringahealingperiodaswellasafterthe integrationofthenewabutmentandthenewsecond- arytelescopeinthebridge,thepatientfurtherusedhis telescopic maxillary restoration (Figs. 16a–d). Discussion Theuseofnaturalteethandimplantstosupportden- turesincursrisksthatmayleadtolossofanabutment and, subsequently, the whole restoration. Recent re- ports have demonstrated a high long-term success rate of removable restorations supported by natural teeth and implants when double crowns, e.g. tele- scopic crowns, are used as attachments.7–9 However, theuseofthecombination,e.g.connection,ofnatural teeth and implants to support fixed dentures is not advisable due to the higher risk of complications.1,10 Cause for the loss of the abutment in case 1 was trauma from a car accident and not mechanical fail- ure or periodontal infection or bone defects. Never- theless, the resulting complications are similar to the ones described in the literature for cases where the above-mentioned causes lead to loss of an implant.1 In case 2, the natural abutment was lost due to mechanical reasons 13 years after loading. This kind of complications, e.g. fractures, have been reported in the long-term maintenance of fixed or telescopic reconstructions, when endodontically treated teeth were used as abutments.11,12 The complication dis- cussed above could be avoided if the endodontically treated last natural tooth abutment #15 was ex- tracted and replaced by an implant. Incasesoffull-archrestorationsretainedonbothim- plantsandnaturalteeth,whenafractureofanatural abutment occurs, removal of the restoration is often necessary, regardless of the type of restoration (re- movable or fixed). This can cause not only conflicts between patient and dentist, but also high financial and technical efforts. The technique described above allowsthesuccessfulreplacementofthefailedabut- ment by an implant, enabling the continuous use of the existing restoration. Editorial note: A list of references is available from the publisher. Figs. 14a & b: Customised gold implant abutment #15 in place; a) X-ray; b) clinical view. Fig. 15: Orthopatomograph taken at the completion of treatment. Fig. 16: Clinical view. contact Prof. Dr Gregory-George Zafiropoulos Sternstraße 61 40479 Düsseldorf Germany Fig. 14a Fig. 14b Fig. 15 Fig. 16 22016

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