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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
case report | Fig. 19: Example of a modern implant with platform switching and additional space for hard tissue. All-on-4 or all-on-five to -six? The follow-up, which was up to six years later, showed a stable hard- and soft-tissue situation with no implant failure. The aesthetic outcome was also stable. These results are similar to those of All-on-4 procedures. The insertion of five to six implants better distributes forces and enables the extension of the prosthesis in case of future complications. Angled implants were not an issue. We saw no need for long implants of more than 13 mm or angulated ones to enlarge the support polygon distally or the bone-to-implant contact. Since we also do not favour immediate function, regular lengths of at least 8 mm, even with sinus procedures, allowed us to easily reach and impress distal implants, relinquish or reduce counter levers. Implants of 8 mm in length do not show significant differences in long-term stability compared with longer implants. At the same time, very long implants, when extracted, lead to major defects, and if loaded under function immediately, can fail, requiring a re-do of all the planning and a re- make of the prostheses. Immediate loading requires at least a 40 Ncm insertion torque. In such cases, co-axial implants are an interesting alternative, since abutments can be screwed on or- tho-radially and aid prosthetic treatment. Yet, there are few manufacturers with such an implant–abut- ment connection, and the implants are of greater diameter. Our patients have lacked functionality and aesthetics for many years; waiting for another three months to receive the final prostheses has never been an issue. Modern implant surfaces such as the Type M implant seem to offer better and faster osseointegra- tion (owing to the B+ surface; MIS Implants Technol- ogies, which provides higher bone-to-implant con- tact), which allowed us to load them after eight weeks, compared with regular surfaces that are to be loaded after 12 to 16 weeks. Implant design Interesting findings were made on the radiographs after loading implants. Whereas implants with ma- chined collars and no platform switching (Type B, Z and C implants) inserted in late defects tended to show a slight vertical bone loss after six to 12 months (establishment of a new biological width), bone level implants with platform switching (Type I and M im- plants) showed no similar findings, especially when inserted immediately or early. Fig. 19 Conclusion The use of screw-retained full-arch prostheses is fully integrated in everyday practice. They offer fixed solutions that are fast and economical compared with bars or cemented prostheses. The premises for treat- ment success are mainly that the replacement of the missing teeth must support lower face soft tissue and the hard-tissue defect vertically should not be major. The patient then receives a highly aesthetic full-arch reconstruction, with high functionality and long- term stability of the hard- and soft-tissue, in four to five appointments and within three to four months without the risks that accompany early or immediate loading. Combined with CAD treatment planning and intraoral scanning, the comfort of the treatment is enormous._ Materials used in this case report: MIS Implants V3 and C1 Implant Systems Conical connection, multi-unit abutments contact A further difficulty encountered was the integra- tion of older implants. These implants were often inserted to support removable prostheses carrying locator or telescopic crowns and were of small diam- eter or misplaced. All of these implants had to receive customised abutments. Dr Nikolaos Papagiannoulis Dental Esthetics Hans-Böckler-Straße 2A 69115 Heidelberg, Germany info@dentalesthetics.de www.dentalesthetics.de Author details implants 4 2017 19