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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
| case report Case 2—Fig. 13: Radiograph before implant placement. Fig. 14: Patient smiling before implant treatment. Fig. 15: Radiograph of the implants placed in the mandible. Fig. 16: Radiograph of the screw- retained bridge in the mandible. Fig. 17: Lateral view of the patient Fig. 13 showing soft-tissue support of the lower face. Fig. 18: Frontal view of the patient smiling. Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 18 implants 4 2017 the mandible. They are elastic, can be milled thinly and are comfortable to wear. Also, full-zirconia frameworks on scan bases are experiencing a revival. Nowadays, we can overcome early childhood dis- eases like framework fracture by removing the weak points coronally by using a zirconia framework pre- pared like teeth and IPS e.max crowns (Ivoclar Vivadent) on them. In this way, if fractures occur, they instead affect the IPS e.max crown, which can easily be milled and applied in only a few hours. Complications In order to eliminate complications, all patients were put on a four- to six-month recall programme. The passive fit of the framework was elementary. Complications were only observed in one case of a mandibular construction at the implant level through screw loosening or framework detachment from the scan base. The prostheses were rebuilt with multi-unit abutments or internal geometry this time. Loosening of the screws retaining a superstructure on multi-unit abutments was not seen as complication and oc- curred only in mandibles. Another important issue is the communication be- tween dentist and dental technician. The framework, especially regarding milling at the implant level, must be planned thoroughly. The technician needs exact instructions on how to mill the emergence profile. If, for example, the soft tissue after re-entry is suffi- cient, but when it comes to the final loading, the emergence profile and the framework are too bulky, gingival recession can occur. This is not true gingival recession, but arises because the part of the frame- work engaged with the implant is too convex. Reduc- ing this part or even giving it a concave form solves the aesthetic problem through lower pressure on the buccal gingiva. Prosthetic components and aesthetics Another important issue is the soft-tissue aesthet- ics. Concave abutments are preferable. They offer space for the soft tissue to build a ring around the abutment, protecting the crestal bone. The more del- icate the abutment, the better the aesthetic outcome. Manipulating soft tissue through implant compo- nents is a smart way to optimise prostheses, but leads to recessions if components are too bulky. Angled abutments especially tend to be too bulky. Addition- ally, they cause pain when inserted because of their pressure on the gingiva. A proper surgery results in sufficient soft-tissue quantity and quality. However, too much soft tissue can be a hindrance in some prosthetic steps. If, for instance, the amount of soft tissue prohibits an intraoral scan because scan bodies are not long enough, conventional methods must be followed.