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ePaper created 2017-09-20, 09:19:59 | version 1.38.0
even more unfavourable axial direction. An overlay with the planning software indicates that the im- plants were inserted into the pre-planned position and direction accurately. Again, the problem of implant-platform exit points which are situated too far lingually is illustrated. Three months later the implants were uncovered and the interim prosthesis was fixed at the distal implants with snap attachments (acc. to Dr R. Laux) and a silicone relining was done. One auxil- iary implant (41) remained (Figs. 10a & b). The aux- iliary implant in position 31 had become loose after three months and was removed during the expo- sure of the definitive implants. The impression was taken as a closed-tray procedure. The follow-up panoramic radiograph shows the good and ten- sion-free seating (passive fit) of the bar-designed superstructure. The remaining auxiliary implant is still very stable. The auxiliary implant will be removed at the time of insertion of the final pros- thesis. The juxtapositioning of the original model to the newly produced prosthesis with PEEK abutments shows that, according to the initial situation, enough room had been created for the tongue (Figs. 11a & b). The final images show the good fitting and seating of the prosthesis. The lingually in white colour visible, delicately designed PEEK abutments do not restrict the patient in any way. Laboratory Part (ZTM Michael Anger) The task here was to allow the patient enough space for his tongue. In spite of digital CBCT–plan- ning, a different positioning of the implants and their axial inclination was not possible because of the bone range. Therefore, we have decided to apply a bar con- struction instead of telescopic attachments in this case, so the friction parts could be located more lat- eral and not in correspondence with the position of the implant platform. Figure 12 illustrates the situation several days after the exposure of the implants and the healing progress. Here, the healing caps were used as im- pression copings. In these pictures, the strong lin- gual inclination of the implant abutments is already visible. Because of the bone volume, a different po- sitioning without augmentation was impossible. The implant impression was made with Impregum®. The taste of this material is not very convenient for the patient and it must harden for at least seven minutes in the mouth. On the other side, the thin texture re- sults in an exact capture of the oral situation and its high final hardness provides the best-possible fixa- tion of the impression posts. Figure 13 depicts the implant impression after disinfection before the in- jection of the gingiva. All mucosal parts should be displayed flawlessly. If there are any impression er- rors, they can be repaired with wax. Ideally, we pro- duce a coherent gingival mask to avoid transitions in Fig. 11a Fig. 11b implants_report Figs. 11a & b: Juxtaposition of original model and prosthesis with Peek abutments. Fig. 12: Final image. Mouth situation after exposing the healing-caps. In the front, the last auxiliary implant is visible. Fig. 13: Implant-impression after disinfection before the injection of the gingiva. Fig. 12 Fig. 13 implants 3_2017 3939