Indication 9 Case 1
Dentist:
Dr.med univ. Günther Dormuth
Bad Vöslau, Austria
Patient:
A 58-year-old partially edentulous male patient (b. 1943). His tooth situation was strongly compromised by severe periodontal damage that had not been prosthetically treated. Tooth 33 was the only (!) intact tooth in the entire mouth.
Pretreatment:
Extraction of all teeth and root remains while protecting, as far as was possible, the alveolar walls with the additional goal of retaining as much of the so-called "red" esthetics, i.e., the profiles of the gingiva and papillae. This was a necessary requirement in fulfilling the patient's wish of having a fixed treatment and impeccable esthetic results.
As immediate treatment, maxillary and mandibular total prostheses were employed (likewise considering the necessity of retaining the remaining papillae). Due to personal and professional considerations on the part of the patient, an excessively prolonged wearing time for the immediate prostheses spanned 14 months, from 7/00 to 9/01.
lmplantations:
Maxilla 6 months after extractions, 6 full screw implants/SLA/Standard
| Regio | Diam | Length |
| 15 | 4.1 | 10 |
| 13 | 4.1 | 12 |
| 11 | 4.1 | 12 |
| 21 | 4.1 | 14 |
| 23 | 3.3 | 14 |
| 25 | 4.1 | 10 |
Mandible 8 months after extractions, 6 full screw implants/SLA/Standard
| Regio | Diam | Length | ||
| 47 | 4.8 | 10 | WI | |
| 46 | 4.1 | 10 | mesial root replaced | |
| 43 | 4.1 | 14 | ||
| 33 | 3.3 | 14 | NNI | (narrow alveolar crest and site of previous delicate natural tooth 33) |
| 35 | 4.1 | 14 | ||
| 37 | 4.8 | 12 | WNI |
In general, a 3-5 mm gingiva was present. Wherever possible and necessary, the implants were inserted in a somewhat sunken fashion, due to esthetic reasons, as is done with Esthetic Plus.
Superconstructions:
Maxilla:
2 bridges set in Degudent H (Degussa) with an individually-tailored "creation surprise" porcelain layering by Willi Geller/Switzerland, each with a distal attachment (16,26), transversal screw fixation
Mandible:
Bridges, as in the Maxilla,
with 3 balancing attachments between 33/34 and 44/45,
Cementing was carried out using temporary attachment cement (TempBond)
Special attention was paid to periodontal hygiene and proper interdental cleaning.
| 17. Oct.00 |
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1
+ 2 Clear template (directly from the wax-up) with measuring and guiding sleeves on the study models (maxilla, mandible) |
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2 |
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1a OPG with a template positioned in situ |
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3 Maxilla model with positioned template |
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4 Maxilla model without template |
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5 Mandibular model with positioned template |
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6 Maxilla model without template |
| 22. Jan.01 |
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7 Maxilla before implantation (mirror image) |
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8 Mandible before implantation (direct view) |
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9 Maxilla after implantation (mirror image) |
| In the maxilla, depending on the position of the stencil, the desired implant positions were first marked in the mouth, the gingiva was punched, and then a crestal cut was made that connected the centers of the punched holes. The next step was the preparation and the opening up of the mucoperiosteal flap, inserting the implants, and closing with sutures. As recommended by Prof. Buser, implants in cosmetically critical areas undergo healing in a half-covered fashion. In the mandible, only punches were made and the flaps were not opened. |
| 21. Jun.01 |
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10 Mandible shortly before impression |
| Note: The slant of the axis appropriately corresponds to the alveolar crest. The axial direction was made according to the alveolar crest and only partially followed that indicated from a prosthetic point of view by the wax-up. This already provides an indication that angled abutments will later be required in some areas. |
| 21. Jul.01 |
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11 Master model of the mandible |
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12 ditto with angled abutments plus bridge frame |
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13 Master model of the maxilla with TS abutments |
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14 ditto plus bridge frame. |
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15 Placing the abutments in the mouth - view from right mandible |
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16 ditto left |
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17 ditto front |
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18 Trying out the mandibular bridge framework in the mouth |
| Here, one can clearly see the deviation of the bite from the middle line with respect to the midline of the face. This must be hidden and requires even more skill by the technical laboratory doing the work. |
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19 Maxillary frame test in the mouth |
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20 Control check bite with frames in the mouth (maxilla and mandible) |
| 11. Septl.01 |
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21 Fitting the TS abutments in the mouth (maxilla) |
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22 Partially angeled abutment positioned |
| 13. Septl.01 |
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23 Finished superconstruction in the mouth: left posterior tooth area (mirror image) |
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24 Ditto right |
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25 Finished frontal view in the mouth |
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26 Finished profile view in the mouth |
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+ 28 Perfect oral hygiene possible |
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28 |
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+ 31 Typical "final smile" by the patient |
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30 final OPG |
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31 Typical "final smile" by the patient |
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Dental
- Labor |
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