A Case of Immediate Loading with a Fixed Detachable Prosthesis and a Removable Definitive Solution via a Denture with Telescopic Attachments
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 3
Abstract
Immediate Loading is mostly appreciated by patients, since they do not have to stay edentulous until the osseointegration. For this purpose there must be an implant system providing abutments suitable for screw retention and a prefabricated restoration. In this case report the procedures for this treatment modality are described in a detailed way. Additionally, the return from fixed to removable upon request of the patient due to easier cleaning was explained, too. The lab procedures and the makeover to a telescopic denture was looked into in this case report. A 70 year old male patient with mandibular teeth showing a poor prognosis due to chronic generalised periodontitis was chosen to treat with a fixed detachable prosthesis [1] supported with 4 implants after extraction of all remaining teeth. Since the lower jaw was causing the main problem, the maxillary treatment was postponed for later on.A preoperative 3-D planning was performed with the help of Dental Volumetric Tomographies (DVT, Galileos Comfort Plus, Dentsply Sirona, Bensheim, Germany) and with the planning software for Guided Surgery (Magellan, Medentis Medical, Bad Neuenahr – Ahrweiler, Germany) (Figure 1). Based on the planning a printed model (Figure 2), surgical guides and a CAD/CAM milled PMMA provisional (Figure 3) were fabricated.The surgical part was achieved with surgical guides making the placement of dental implants flapless and exactly in the same position as originally planned [2,3]. Implantation in the positions 34, 32, 42, 44 with immediate loading via a milled prefabricated PMMA provisional which is a high performance acrylic (ICX- Smile Bridge, Medentis Medical, Bad Neuenahr – Ahrweiler, Germany) was accomplished. This technique is not new; it was introduced by Malo and colleagues [4]. Following this protocol, the implants in the positions 32 and 42 were placed straight, whereas the distal implants were placed with an angle of 35 degrees (positions 34 and 44). The use of angulated implants gives the possibility to prevent complicated sinus lifting or augmentation procedures and protect anatomic structures such as the foramen mentale. The used implant system gives the possibility to use two different degrees: 17 or 35. It is important to achieve a primary stability of the implants of at least 35 Ncm, to be able to load them immediately [5-7]. The next step was to mount the occlusally screwed abutments (Multi Abutment, Medentis Medical, Bad Neuenahr – Ahrweiler, Germany) on the implants and take care of the right gingival height. After checking the fit and occlusal stability of the Smile-Bridge, the fixation intraorally was succeeded with an autopolymerising denture repair polymer of diacrylate base (QU-resin,Bredent, Senden, Germany). After torque-wrenching of the fixation screws, the screw holes were closed with a light-cured provisional material (TELIO CS Inlay, Ivoclar Vivadent,Schaan,Liechtenstein)
Authors and Affiliations
Krischik D, Saiz D, Orten A Van, Hakan Bilhan
Keywords
Related Articles
- EP ID EP570501
- DOI 10.26717/BJSTR.2017.01.000262
- Views 187
- Downloads 0
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