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The dentists meets a 74 years old patient who was carrying a prosthesis since many years. The patient’s request is to improve both the aesthetic and functionality of the prosthesis. First exam was showing a difference between the total upper prosthesis, old and damaged, and the total lower prosthesis, which was recently built over 4 implants.
In the group practice run by Dr. K. L. Ackermann and Dr. A. Kirsch, a 30-year-old patient presented requesting a natural and balanced anterior appearance (Fig. 1a and 1b): tooth 12 was not worth retaining. The condition of the bone was inadequate, the contours of the gingival margin were uneven, and the teeth in regions 12 and 22 were not the same width. On consultation with the patient, the width of the crown on tooth 12 was to be tailored to match tooth 22, and accordingly, a gap retained between tooth 11 and 12.
There are three parts to a two-piece implant. Of course, there is the actual implant (part one) and the abutment with screw (part two), as seen in Figure 1. But it’s the third part that has been the focus of discussion in recent years.
This third part forms only when the first two are assembled: it’s the microgap, which resides in what is called the trans-mucosal zone or the emergent profile. See Figures 2 and 2A. The microgap is the place where the implant and the abutment meet, above the bone but below the tissue. Of primary concern, it’s where bacteria can breed, causing
maintenance and hygiene issues, or even implant failure.
The case: One of four abutment teeth falls out and reduces the friction of the telescopic
denture in the anterior region. In addition, the patient is missing parts of their forward
gums due to illness. An immediate implant has already been installed. In the second part
of his article, Axel Mühlhäuser describes the production of the secondary construction.
When full implant dentures requiring a milled bar is prescribed, the proper protocol and
procedure are of extreme importance. The proper impression, bite registration, verification index, denture tooth set-up, internal framework and bar design are of the utmost importance. There are too many instances where the doctor wants to take a
shortcut by eliminating the verification index or the set-up. Both of these procedures are a must for a successful overdenture case.
How can a bar restoration be implemented on five Camlog implants using CAD/CAM technology? This was a question that Master Dental Technician, Marcus Westenberger kept asking himself. In the following article, Westenberger provides a clear overview of how he got from the planning phase to the perfect result.
There are situations when in the total edentulous arches after implants were inserted, fixed dental works may be
achieved. The patients want fixed, metal ceramic or zirconium – based works most frequently, but in some cases, when due to patients’ osseous substance, implants insertion may be achieved only in certain areas without applying augmentation or bone grafting, and in these situations we have to adapt to the case. Typically for these situations, fixed prosthetic works can no longer be achieved and different types of anchored works by means of telescopes, spherical systems, locator or Dolder systems are considered.
The aesthetic setup of this type of works is ensured by light materials of composites kind.
Especially for crown and bridge prosthetics CAD/CAM manufactured restorations have become standard. The use of digital techniques allows us to economically create reproducible prostheses of high quality. There is a
wide range of usable materials available, from acrylics to ceramics and metals. In addition the range of indications increases have also expanded the field of applications for this technique.
Patients with implants may need a long-term temporization solution while the clinician manages the tissue and gum area and waits for it to heal. This can take some time and may require quite a bit of patience on everyone’s
part. Our case study patient understood that it would take some time to restore her teeth and that temporization was an important step in the process.
These days, good organisation and optimal timing combined with the correct use of materials and technology are essential if dental work is to be a success. Standards of precision and safety must never fall, despite today's
increasingly tough price competition. Therefore, we should wherever possible use materials that can help us to maintain these standards.
The diagnosis of hypodontia of the lateral incisors usually requires using implants to replace the missing teeth, yet this method is only applicable if the initial situation is ideal. In the following article, the authors discuss a therapy approach for a more complicated initial situation.