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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
case report | Fig. 2 Fig. 4 Fig. 3 Fig. 5 plants parallel. As a result, only four jaws and eight implants needed angled multi-unit abutments. No second molar was replaced in any case, but one pa- tient received restoration up to the second premolar, since the molars were retained and received regular full-ceramic crowns (Table 2, see QR Code Tables). Prosthetic components All of the angled multi-unit abutments were two- piece abutments. The B and C systems offered one- and two-piece straight abutments. System C compo- nents had a snap-on function that often simplified their insertion—though not in all cases. All of the sys- tems offered components with anti-rotation be- tween the multi-unit abutment and implant. If com- ponents without anti-rotation to the implant were used, they needed to remain inserted after the initial probing. Components with an anti-rotation function between the multi-unit abutment and framework or titanium sleeve were very useful. The insertion of an- gled abutments was time-consuming without a jig. Angled abutments were inserted with customised titanium sleeves, since no abutment carrier was sufficient for insertion. Special insertion adapters were necessary for almost all manufacturers (apart from Type D implants). A very practical abutment design was deter- mined for Type I and M implants. Combining plat- form switching and a concave abutment design of- fers much space for crestal bone and soft tissue to build a ring around the implant neck, protecting it in the long term. Type M implants offer even more space for crestal bone and soft tissue through the triangular design of the implant neck. Together with the gold-anodised prosthetic components and emergence profile, aesthetics is realised more easily than with other systems (Figs. 1a–h; Table 3, see QR Code Tables). Case 1—Fig. 2: Lateral view of the face with the patient wearing the provisional prosthesis. Fig. 3: Frontal view of the face with the patient wearing the provisional prosthesis. Fig. 4: Radiograph before implant placement. Fig. 5: Radiograph after implant placement. Manufacturing and milling Screw-retained full-arch constructions show many advantages over cemented ones. They are easy to realise and repair. From re-entry until final loading of the implants takes three to four appointments and three weeks. Especially in combination with digital impressions and 3-D-printed models, the manufac- turing time and costs can be reduced to a minimum. Apart from the re-entry, all other appointments are short, only up to 30 minutes. Cast frameworks (non-milled) are quite expensive and subject to ten- sion. In contrast, milled frameworks showed no ten- sion at all and no steps had to be repeated. The mandibles were treated with multi-unit abut- ments. There was only one exception of a mandible being treated with a framework at the implant level, because no milling centre that we worked with was able to mill an internal hexagon geometry of 3 mm. The maxillae were treated with scan bases or directly at the implant level. The maxilla is not mobile and therefore is not subject to torsional forces as the mandible is. Through this solution, we reduced potential weak points to a minimum, having only one, the screw fixing the framework to the implant. In the mandible, there are two potential weak points: the screw to the implant and the screw to the multi- unit abutment. Nevertheless, in this study, two maxillae were treated with multi-unit abutments because either the milling centres were not able to implants 4 2017 13