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ePaper created 2017-05-12, 09:42:21 | version 1.38.0
industry | Fig. 6a Fig. 6b Fig. 6c ence on the need for augmentation. The question of the resorption status of the jaw is also important because narrowing of the alveolar ridge and verti- cal resorption does not occur locally or in isolation but is associated with resorption-related progna- thism and a relative transversal narrowing of the upper jaw. Because checking the basis for the pros- thetic and surgical planning is difficult because of the lack of options for orientation to the remaining teeth, 3-D planning checks may be useful. All aug- mentation techniques can be applied according to the desired prosthetic concept and the defect situ- ation given. Alternative to augmentations can be the application of angled implants. Augmentation alternative in complete edentulism The analogous names for these restorations are sci- entifically “all-on” restorations or the brand modifi- cations derived from this, “All-on-4” (Nobel Biocare) or “Pro Arch” (Straumann). Angled implants are one option to avoid the maxillary sinus and the inferior al- veolar nerve while still achieving a broad support polygon with no vertical bone augmentation.22–25 They are therefore an option for cases in which bone augmentation is not possible and, where applicable, also for immediate load indication (Figs. 2a–l). The restoration must be splinted. Experience supports the data in the literature and shows good results. It is rec- ommended for this application to interlock over an implant bridge, which allows a mechanically favour- able force distribution. Alternatively, a bar restoration is possible for a removable prosthesis and for certain bite heights makes sense in principle. The technique was and is still hotly debated. For the correct indica- tion and when carried out correctly, the method is, however, a good option for certain patient groups. Fig. 6: Stable GBR technique with titanium PTFE mesh: a) horizontal defect situation; b) simultaneous implant insertion (Straumann BLT SLActive), autogenous bone augmentation and Neoss PTFE mem- brane as the shell; c) closed and fixed with KLS Martin osteosynthesis screws. Fig. 7a Fig. 7b Fig. 7c Fig. 7d Fig. 7: Autologous shell using the Khoury technique: a) defect situation in the upper right jaw; b) status after three months regio 26 and 27; c) another three months after implant insertion; d) result after soft tissue management. implants 2 2017 35