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ePaper created 2018-01-31, 10:01:59 | version 1.38.0
| industry report Fig. 7 Fig. 8 Fig. 9 Figs. 7 & 8: The drilling template and the pre-fabricated temporary restoration with palate for optimum positioning. Fig. 9: Inserted implants with the corre- sponding superstructures for the SKY fast & fixed concept. severely damaged periodontally. A fixed restoration was requested. The high mobility grade of the teeth would not permit a stable anchoring of a new dental prosthe- sis. Therefore, following a discussion with the patient, ex- traction of the teeth and immediate implant prosthetic restoration was planned in accordance with the SKY fast & fixed concept. Planning As a planning base, a situation model was initially produced (Fig. 2). This was digitalised in the laboratory scanner (D800, 3Shape) and an STL data set was cre- ated. In order to validate the implant positions, the two-di- mensional X-ray image only yielded limited information about the available bone (Fig. 3). A three- dimensional im- age (DVT) was therefore compiled, without a scan tem- plate being required for this. Thanks to the allocation of space for the anatomical structures, a detailed analysis of the jaw was now pos- sible. Using the planning software (coDiagnostiX, Dental Wings), six implants were planned in the local bone based on the visualisation of the anatomical structures and the digital set-up (ideal position of the prosthesis; Fig. 4). By angling the distal implants, anatomically vital structures were circumvented and augmentation mea- sures avoided. The angle of the implants is between 30 and 45 de- grees for the SKY fast & fixed concept. In addition to the individual surgical components, special prosthetic su- perstructures are integrated in the complete concept. A drilling template for the navigated implant insertion and a temporary restoration were created from the planning software for the immediate restoration (Figs. 5 & 6). In or- der to guarantee accurate positioning in the mouth, both objects were designed with a palate, whereby the tem- porary dental prosthesis is produced with target fracture sites, in order to guarantee a palate-free design of the screwed bridges (Figs. 7 & 8). Implantation and immediate restoration At the time of the surgical procedure, the existing teeth were extracted atraumatically and six implants (blueSKY, bredent medical) were inserted with the help of the drilling templates. The implants were inserted in a primary stable manner with a torque of between 30 to 45 Ncm (Fig. 9). The abutments were applied and the area sutured. The pre-fabricated temporary restoration was inserted with- out an impression needed. The palate provided support in order to ensure the reliable referencing of the mouth. The temporary restoration was bonded with the abut- ment for a tension-free intraoral fit (Qu-resin, bredent medical), lined and the bridge was then processed and produced (Figs. 10 & 11). Fig. 10 Fig. 11 Fig. 10: Long-term temporary restoration with target fracture sites in front of the intraoral adhesion and lining. Fig. 11: Bridges screwed onto the implants (long-term temporary restoration following removal of the palate) for immediate restoration. 28 CAD/CAM 1 2018