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ePaper created 2016-11-23, 14:26:06 | version 1.38.0
| case report 12 implants 4 2016 Straightforward advanced complex in dental implantology Authors: Dr Rolf Vollmer, Dr Patricia Wieschollek and the laboratory team of Michael Anger, Germany Introduction SAC(StraightforwardAdvancedComplex)defines the level of difficulty in dental implantology. Origi- nally created by the ITI team in order to describe dif- ficulties in dental implant surgery, this term has also beenappliedandadaptedtodentalprosthetics.This article presents a surgically moderately difficult but prosthetically highly demanding case. The special difficulty arose when the implant position was planned in a perfect alignment but impeding the prostheticrestoration.Inclosecooperationwiththe dentallaboratoryandduetobackwardplanning,the patient could be provided with an individual, if not even unconventional solution. Case presentation Years of progressive refractory horizontal bone loss with alternating acute periodontitis were ob- servedinthepatient(Fig.1).In2011,whenthepatient was43yearsold,theremovalofallteethinthemaxilla andtheinsertionofafulldenturetookplace.Sincehis sensationsoftastewerestronglyaffectedbythepal- ate cover, the decision was made for implantation of sevenimplantsinthemaxilla,suppliedwitharemov- able cover denture telescope prosthesis with bonded secondary parts in Galvano or electroforming tech- nique (Figs. 2 & 3). In 2015, there was a recurrent severe periodonti- tis in the mandible and extremely strong loosening ofallthelowerteethinthenow47-year-oldpatient (Fig. 4). So, definitive treatment planning for the mandible was necessary. The mandibular incisors had to be removed in advance because of their missing stability. Due to the patient’s severe gag reflex,implantationundergeneralanaesthesiawas provided. The removal of all remaining teeth with simultaneous implantation and insertion of two Fig. 1: Initial situation in maxilla and mandible. Figs. 2 & 3: Insertion of a full denture in 2011. Fig. 4: The CBCT planning shows the scheduled implant positions in the mandible and the exit points of the abutments in relation to the teeth before extraction. Fig. 1 Fig. 2 Fig. 3 Fig. 4 42016