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8 mCME Dental Tribune Middle East & Africa Edition | 2/2017 Intraoral welding and lingualized (lingual contact) occlusion: a case report CAPP designates this activity for 1 CE Credits mCME articles in Dental Tribune have been approved by: HAAD as having educational content for 1 CME Credit Hours DHA awarded this program for 1 CPD Credit Points By Dr. Luca Dal Carlo, Dr. Franco Ros- si, Dr. Marco E. Pasqualini, Dr. Mike Shulman, Dr. Michele Nardone, MD, Tomasz Grotowski, Dr. and Sheldon Winkler Intraoral welding was developed by Pierluigi Mondani1 of Genoa, Italy, in the 1970s to permanently connect submerged implants and abutments to a titanium wire or bar by means of an electric current (Fig. 1). The cur- rent is used to permanently fuse the titanium to the abutments in milli- seconds, so the heat generated does not cause any pathology or patient discomfort. If possible the implants are placed without fl aps. The titanium wire or bar is bent and aligned passively to the contour of the labial and lingual surfaces of the implants before ap- plying the electric current to perma- nently connect titanium implants. The technique follows a strict sur- gical and prosthodontic protocol, which includes using a number of implants as close as possible to the number of teeth to be replaced, achieving primary stability by en- gaging both cortical plates (bicorti- calism), immediate splinting of the implants utilizing intraoral welding and immediate insertion of a fi xed provisional prosthesis with satisfac- tory occlusion. The technique pro- vides for immediate loading and does not jeopardize the integration process.2 Although intraoral welding has been used successfully in Europe, especial- ly Italy, for many years, it has yet to achieve everyday use in the United States. Members of the Italian affi liate of the American Academy of Implant Prosthodontics, NuovoGISI, have long and successful experiences with immediate loading of maxil- lary implants connected together by intraoral welding.2 By inserting the prosthesis with ad- equate retention and stability the same day as the surgery, patient complaints and discomfort can be avoided or substantially reduced. The instantaneous stability that re- sults from the splinting can reduce the risk of failure during the heal- ing period. Intraoral welding can also eliminate errors and distortions caused by unsatisfactory impres- sion making, as the procedure is per- formed directly in the mouth. Intraoral welding can fulfi l a great need for business and socially active ÿPage 9 mCME SELF INSTRUCTION PROGRAM CAPPmea together with Dental Tribune provides the opportunity with its mCME - Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the fl exibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership Yearly membership subscription for mCME: 1,100 AED One Time article newspaper subscription: 250 AED per issue. After the payment, you will receive your membership number and allowing you to start the program. Completion of mCME • • • • • • • • mCME participants are required to read the continuing medical education (CME) articles published in each issue. Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on www.cappmea.com/ mCME/questionnaires.html. Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. A minimum passing score of 80% must be achieved in order to claim credit. No more than two answered questions can be submitted at the same time Validity of the article – 3 months Validity of the subscription – 1 year Collection of Credit hours: You will receive the summary report with Certifi cate, maximum one month after the expiry date of your membership. For single subscription certifi cates and summary reports will be sent one month after the publication of the article. Fig. 1. Schematic drawing of Mondani intraoral solder unit Fig. 2. Preoperative panoramic radiograph of 50-year-old cauca- sian woman Fig. 3. Nonrestorable teeth visible after removal of the patient’s pros- thesis Fig. 4. Eight titanium one-piece implants are inserted. Fig. 6. Panoramic radiograph after 90 days suggests complete integration Fig. 5. Immediate stabilization of the eight implants and two additional implants previously inserted in the posterior regions, by welding each implant to a 1.5 mm supporting titanium bar Fig. 8. Lower implants welded together intraorally Fig. 7. Healthy gingiva was observed after 90 days Fig. 10. Seven-year follow-up radiograph shows satisfactory pres- ervation of bone surrounding all of the implants The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE. Fig. 9. Three-tooth mandibular fi xed prosthesis Fig. 11. Intraoral photograph of the defi nitive prosthesis shows healthy gingiva