logo 17 • CAMLOG Partner Magazine • March 2018 26 Fig. 20: The soft tissue was sutured around the PEEK healing caps that were mounted on the bases. Situation ten days after exposure. Fig. 19: The implants are well osseointegrated. The PEEK cover caps were removed and the implant bases were inserted. Fig. 21: PEEK healing cap removed; view of the screw-retained implant base. Fig. 14: The stable bone attachment to the implant shoulder is clearly visible on the X-ray image. Fig. 15: The Locator® prosthesis in the mandible after 3.5 years in situ. Fig. 13: The clinical situation proved stable after 3.5 years. one can use a direct chair-side procedure: The Locator® housings are polymerized into the prepared prosthesis directly in the mouth. After oral hygiene instructions, the patient was integrated into a sixmonth tooth cleaning recall program. The Figures 13 to 15 show the situation 3.5 years after restoration. The patient has coped well with the chosen solution and is very satisfied with the function of the prosthesis. The second case – restoration of a free-end situation The second patient case illustrates the restoration of a unilateral free-end situation in the mandible. The female patient had been treated elsewhere about 7 years prior with a telescopic prosthesis on six implants in the maxilla and a fixed implant-supported prosthesis in the anterior mandible. In the fourth quadrant, a free-end situation had arisen after the loss of all abutment teeth of a long-span bridge. The crestal width of the bone bed was clearly atrophied and additionally showed a low residual bone height above the inferior alveolar nerve (Fig. 16). In order to carry out an implant restoration in the fourth quadrant with acceptable effort, an implantation with simultaneous autologous augmentation using length-reduced implants was chosen. iSy Implants with the dimensions 3.8 × 9 mm and 4.3 × 7.3 mm were used. The autologous block augmentation performed at the same time as the implantation, together with the patient’s wish to be able to wear an interim prosthesis postoperatively, made submerged healing necessary (Fig. 17). Figure 18 shows the situation during exposure: one can recognize the implants covered with the PEEK cover caps and the well-healed autologous block augmentation with the micro-osteosynthesis screws in situ. For exposure purposes, the attached PEEK cover caps were first removed (Fig. 19). The implant bases that had been removed for submerged healing were reinserted as primary healing caps and the provided PEEK healing caps included with the implants were attached. These offer simple but effective soft tissue shaping for the first ten days after exposure (Fig. 20). Impression taking After ten days the sutures were removed and the impression was taken during the same appointment. Several alternatives are available for impression taking: conventional screw-retained impression posts for open or closed impression technique, scanbodies or posts for intraoral scanning or simply the use of the multifunctional caps supplied with the implants as in the case illustrated: For this purpose, the multifunctional caps are mounted on the implant base and an implant impression is taken using the closed impression technique (Figs. 21 to 23). It should only be noted here that the multifunctional caps should be shortened occlusally if necessary in order to avoid pushing through onto the tray as this may reduce the accuracy of the impression. As the implant base is fully approved for use as a definitive abutment or adhesive CASE STUDY
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