Implant Tribune Middle East & Africa Edition No. 6, 2017

D2 IMPLANT TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2017 The use of CBCT and CAD/CAM techniques in complex implant-supported rehabilitation of maxilla—Part I By Dr. Tomasz Śmigiel, Poland Introduction Patients who visit our clinic and wish to receive prosthetic treatment are frequently unaware of the possi- bilities that modern medicine has to offer. Neither are they aware of the fact that implantological treat- ment is not a ‘one-day’ treatment and that the integration of implants with bone tissues takes some time. That time can range from several weeks to several months. What they are also unaware of is the fact that after some time from the moment the teeth have been extracted, the bone will atrophy and hence it is of- ten necessary to perform augmen- tation procedures first before dental implants can be placed. Therefore, a complete treatment may last from several months to up to a year. As a result, the temporary prosthetic restoration, which the patient will have to use till the end of the treatment, is recommended. It is important to notify the pa- tient that following augmentation procedures, using bone blocks and biomaterial, it is inadvisable to use a functionally unstable prosthesis as it may damage the augmentation material and damage the prognosis connected with the graft’s integra- tion. As a result, in such cases one may ap- ply a temporary prosthesis based on telescopic crowns as the whole load will be transferred onto teeth or im- plants, not the mucosa. Telescopic prostheses are a type of prostheses that are not functionally unstable, unlike ordinary acrylic prostheses or some other skeletal types. Case report A 62 year old patient with residual dentition used an ordinary acrylic prosthesis. The main reason why the patient wished to change the prosthesis was discomfort due to the fact that the palate was covered up while the prosthesis was mov- able. In order to obtain maximally precise diagnostics, a demonstra- tive panoramic photograph was taken as well as CBCT. Fig. 1: Analysis of the scope of teeth exposure—mouth slightly open Fig. 2: Analysis of teeth exposure—maximum scope of smile During the process of treatment planning, a few proposals for pros- thetic solutions were presented, in- Fig. 3: Analysis of implantation possibil- ity based on CBCT of the frontal region: vertical dimension 16.1 mm, horizontal dimension 5.4 mm. Fig. 4: Analysis of implantation possibility based on CBCT of the left frontal region: vertical dimension 17.2 mm, horizontal dimension 4.2 mm. Fig. 5: Analysis of implantation possibility based on CBCT of the right-side maxillary sinus region: vertical dimension 5.6 mm, horizontal dimension 10.4 mm Fig. 6: Analysis of implantation possibil- ity based on CBCT at right-side maxillary sinus region: vertical dimension 4.7 mm, horizontal dimension 6.4 mm Fig. 7: Preparation for taking impressions. Closed tray impression copings mounted onto the implants. Fig. 8: An impression taken on an individ- ual tray—Impregum. Implant analogues together with impression copings placed within the impression. cluding permanent and temporary restorations, based on existing teeth as well as implants of various combi- nations. After analysing CBCT scans (Figs. 3–6), it could be concluded that implantological treatment may be performed at the front maxilla without any additional procedures. However, due to significant atrophy in the lateral part and a low lying fundus of the left and right maxil- lary sinus, it appeared necessary to perform augmentation procedures (sinus lift), in order to make implan- tation possible. It became clear that treatment in this case would require more time and hence in the period between procedures, from the mo- ment treatment began till the time the final prosthesis was accepted, the patient should be provided with a convenient temporary restora- tion. Being fully aware of advan- tages and disadvantages of different solutions, the patient decided on a restoration based on eight implants with a combined mounting and the use of screw-based abutments and telescopic crowns of implants. Ap- plication of telescopic crowns at the front of the maxilla allowed us to make a very convenient temporary restoration, partial prosthesis based on four telescopes. ÿPage D3

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