Dental Tribune Middle East & Africa Edition | 4/2020 IMPLANT TRIBUNE C3 ◊Page C2 Surgical procedure After a careful crestal incision, keeing the edge of the blade always in con- tact with the thin bone ridge, a cen- tral release incision was performed. The flap was raised to obtain a clear view of the underlying bone (Fig. 3a). In the area of the left incisor, the ridge appeared to be too thin for im- plant placement, probably owing to a previous cystic lesion. The implant that had initially been planned in region 32 was therefore moved to region 33. For the implants in regions 42 and 34, the site was prepared se- quentially with the needle drill (1.6 mm diameter) and the pilot drill (2.2 mm diameter), while only the same needle drill was used for the im- plants in regions 44 and 33. During the preparation of the implant sites, parallelism was verified at all times through the parallel posts (Fig. 3b). Fi- nally, the four implants were placed in the respective sites, initially using the vial caps and then inserted and stabilised with the Optiloc® ratchet adapter and the ratchet itself (Fig. 4a). The flap was closed with a 4/0 polyamide continuous suture (Figs. 4b & c). Owing to the thin bone crest, immediate loading was avoided by grinding resin from the existing prosthesis in order to prevent con- tact with the transgingival part of the implants during the healing phase. Prosthetic procedure After a healing period of six weeks, the patient was referred to the Divi- sion of Gerodontology and Remova- ble Prosthodontics at the University Clinic of Dental Medicine in Geneva in Switzerland for the final rehabili- tation of her completely edentulous maxilla and mandible, with the Straumann® Mini Implants placed in the latter. During the first con- sultation, preliminary impressions were taken using an irreversible hy- drocolloid impression material. Si- multaneously, the patient’s conven- About the author Dr Nicola Alberto Valente graduated in dentistry from the University Cattolica del Sacro Cuore of Rome, Italy. He completed his Master of Science in Oral Sciences and his specialty program in periodontics at the State University of New York at Buf- falo, NY, USA. He is a Diplomate of the American Board of Periodontology and has had an ITI Scholarship from the Uni- versity of Geneva, Switzerland. He has worked as Chef de Clinique in the Unit of Oral Surgery, Service of Maxillofacial Surgery of the University Hospitals of Geneva, University of Geneva until 2019. He will start his new duties as Clinical As- sistant Professor at the State University of New York at Buffalo in 2020. Dr Nicola Alberto Valente University at Buffalo School of Dental Medicine 250 Squire Hall, 3435 Main Street Buffalo, NY 14214, USA www.dental.buffalo.edu tional mandibular CD was relined using a functional impression tis- sue conditioning material for better interim retention. In the maxilla, a conventional impression was taken using a customised impression tray, enabling a mucodynamic border moulding followed by a mucostatic final impression using zinc oxide eugenol impression material. In the mandible, the Optiloc® impression/ fixation matrices were placed on the Optiloc® before a mucodynamic impression was taken with an elas- tomeric polyvinyl siloxane (PVS) impression material (Figs. 5 & 6). The preparation of the master models and corresponding wax rims and all subsequent laboratory works were carried out in the Swiss-based dental laboratory Zahnmanufaktur Zim- mermann und Mäder in Bern using the Optiloc® analogues and standard techniques (Fig. 7a). The next clinical steps included verification of the up- per and lower lip support (ensuring aesthetic teeth exposure), checking the occlusal planes, defining the ver- tical dimension of occlusion, and fi- nal bite registration (Figs. 7b–d). Communication with the dental laboratory using photographs of the patient’s natural dentition was a key factor for successfully prepar- ing the final teeth set-up (Figs. 8a & b). During try-in, the final set-up was checked for lip support, occlusal planes, teeth exposure and occlusal contacts (Figs. 9a & b). Moreover, the patient was able to suggest modifi- cations and give her consent before the final prostheses were prepared. To prevent fractures and ensure the longevity of the mandibular IOD, a polyether ether ketone (PEEK) rein- forcement was incorporated in the final prosthesis (Fig. 10). The new conventional maxillary CD and mandibular IOD on the Optiloc® retention system was then finalised in the dental laboratory, placing the Optiloc® housings and processing inserts on all Optiloc® model ana- logues and following the usual man- ufacturing procedures. The dental laboratory delivered the completed maxillary CD and mandibular IOD (Figs. 11a & b). During the final con- sultation, the appropriate retention inserts (low force) Optiloc® were se- lected and inserted into the housings using the Optiloc® retention insert placement tool (Figs. 12 & 13). The completed conventional maxillary CD and mandibular IOD were then inserted into the patient’s mouth, and final post-insertion and denture hygiene instructions were given to the patient (Figs. 14a & b). Conclusion The case was successfully handled. The patient was highly satisfied and reported increased functional com- fort and social confidence. The use of four 2.4 mm diameter Straumann® Mini Implants to support a man- dibular overdenture has proved to be a reliable technique, which guar- anteed satisfactory results both for the operator and the patient in a case where traditional techniques with larger diameter implants were not possible. Editorial note: The surgical procedures were per- formed by Dr Nicola Alberto Valente and prosthetic procedures by Dr Nicole Kalberer supervised by Dr Mu- rali Srinivasan. AD e Danube Private University: Studying where others go on holiday – in the Wachau UNESCO World Heritage Cultural Landscape © omas Eder Do not miss out on the opportunity of university-based continuing education Master of Science in Oral Surgery/Implantology (MSc) Academic Director: Prof. Dr. Dr. Ralf Gutwald The fi elds of implantology and oral surgery are important elements of dental and oral medicine, and they support and complement each other unequivocally in their understanding. Implantology is thereby one of the major growth areas in dentistry. No other fi eld has developed as strongly, from a diagnostic, therapeutic and scientifi c perspective, in recent years. Other factors, such as demographic developments, multimorbidity among older patients and the constantly changing spectrum of medicine with new therapy possibilities, also place new and increasingly greater demands on surgical treatments. The needs of the patients should thereby not be forgotten. Despite the general trend towards specialization, the majority of patients want holistic treatment from their family dentist. It therefore goes without saying that the practice of today should also offer implantology and oral surgery. Anyone who has dealt with implantology and oral surgery, wants to expand their intellectual and manual spectrum. One should not immediately push oneself to one’s limits, but rather subject oneself to a well-founded scientifi c learning process. The knowledge transfer of secure concepts and alternatives, combined with manual skills, aims to enable the participants of the Master of Science in Oral Surgery/Implantology programme to also master the demands of successful implant insertion and surgery in complicated situations and to also handle complications with confi dence. This university course meets the modern and increasingly surgical demands. Rise to the challenges of a modern society’s expectations and qualify yourself for the future. Master of Science in Periodontology and Implantology (MSc) Academic Directors: Prof. Dr. Dr. Moritz Kebschull MBA & Prof. Dr. Dr. Ralf Gutwald The knowledge of how infl ammatory periodontal destructive processes occur has been improved and expanded over the past years. New therapy approaches have been developed to complement mechanical therapy. These have themselves made major progress in terms of methodology and instruments. The contemporary demand for the preservation of tissue with regeneration potential, has led to the replacement of generous periodontal fl ap surgery with graceful, reconstructive and repairing methods that are capable of satisfying even the highest aesthetic standards. The perfect anchoring of implants of the jawbone and peri- implant mucosa should be improved by the enhancements using plastic surgery methods. There are also processes in the mucous membrane and the peri-implant bone – caused by microbial biofi lm – that can be compared to those in the marginal periodontium. All periodontal therapeutic measures and implants, without exception, require personal and professional follow-up care. The daily oral hygiene includes mechanical, hydrodynamic and chemical aids, in accordance with the patient’s manual abilities. For further information on our university-based Master of Science continuing education programmes please contact: PUSH Information Offi ce Bonn, Ms. Irene Streit (Mag.) Tel .: +49 228 96 94 25 15 e-mail: streit@dp-uni.ac.at or info@dp-uni.ac.at Danube Private University (DPU) - Faculty of Medicine/Dentistry Steiner Landstraße 12, 3500 Krems-Stein, Austria www.dp-uni.ac.at