Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-12-06, 12:03:50 | version 1.38.0
| case report Rehabilitation of edentulous patients Author: Dr Nikolaos Papagiannoulis, Germany Tables Figs. 1a–h: Multi-unit abutments. a) Type B straight. b) Type B angled. c) Type C snap-in. d) Type C straight. e) Type T straight. f) Type T angled. g) Type M straight. h) Type M angled. The prosthetic rehabilitation is the last step in implant therapy. The ageing of the population, the demand for aesthetics and functionality at advanced ages, and the establishment of implants as a regular therapy increase the edentulous situations that must be treated yearly. In this study, we examine full-arch treatments with screw-retained fixed prostheses. In Table 1 (see QR Code Tables), a decision tree for decid- ing whether fixed or removable prostheses are the appropriate solution for the patient is shown. While fixed prostheses are more favourable in the case of sufficient bone volume or only minor bony defects and good patient compliance, removable ones are preferable in the case of major vertical defects or in- sufficient soft-tissue support (in addition to a lack of compliance). In this study, we treated 23 edentulous jaws. In total, 133 implants were placed, 94 in the maxilla and 39 in the mandible. All of our patients fulfilled the criteria shown in Table 1 (see QR Code Tables): no or low vertical and lateral bone defects, replacement of the teeth was sufficient for soft- tissue support, hygiene was ensured in every case, and implants were placed in the proper prosthetic position. Manufacturing and implantation Three jaws received cast frameworks melded at the laboratory, whereas 12 were CAD/CAM-milled at multi-unit abutment level. The remaining eight frameworks were milled at implant level (either with internal geometry or on a scan base abutment). The major implant types used were anonymised into B, I and M, while implant Types Z, C and two others refer to older implants integrated into the new prostheses. Three implants were lost during healing owing to low primary stability and lack of osseointegration. All three implants were replaced immediately with slightly wider ones, since no signs of inflammation were evident. The All-on-4 protocol (Nobel Biocare) was deliber- ately avoided, since its limitations influence long- term therapy success. Nevertheless, two patients (both maxilla) received only four implants. Both pa- tients were over 80 years old and in neither of the cases were implants angulated more than 15°. Gener- ally, we tried to avoid angulated implants. In contrast to the All-on-4 concept, we chose to insert the im- Fig. 1a Fig. 1b Fig. 1c Fig. 1d Fig. 1e Fig. 1f Fig. 1g Fig. 1h 12 implants 4 2017