logo 17 • CAMLOG Partner Magazine • March 2018 28 with a zirconium oxide framework and individual veneering was chosen (Figs. 28 to 30). The denture was bonded semidefinitively to the individual zirconium oxide abutments with a carboxylate cement. Then the patient was integrated into a tooth cleaning recall program. Figures 31 and 32 show the final situation clinically and in an orthopantomogram. Discussion The first patient case presents the restoration of an edentulous mandible with four interforaminal implants. Since the iSy System is designed for open healing, a transgingival healing or, alternatively, an immediate loading protocol are possible with little effort. While immediate loading of primary splinted implants via a bar restoration can be regarded as safe, submerged healing over three months is the preferable choice for single implants. This applies in particular if simultaneous augmentations are performed and/or a mucosa-supported prosthesis has to be worn over the implants during the healing period, as was the case here. In this case, the slightly subcrestal implant position of the iSy Implants is helpful to avoid possible healing interference due to denture pressure points. The second patient case shows the typical scenario of advanced alveolar process atrophy, characterized by simultaneous bone loss in height and width. While the build-up of the alveolar ridge width can be achieved safely and with long-term stability by autologous augmentation and with acceptable effort, the build-up of the alveolar ridge height is much more complex and difficult to achieve. For this reason, a number of implant manufacturers now provide length-reduced implants. In the literature, a length of < 8 mm is generally considered to be “reduced in length.” The dogma that a crown-implant ratio of more than 1:1 and/or implant lengths of less than 8 mm must be considered as critical factors for the long-term success of rehabilitation with implants has since been disproved by many long-term studies [6,7]. If the prosthetic planning criteria are adhered to and the implants are securely anchored in sufficient (augmented) bone, then lengthreduced implants demonstrate the same survival rates as conventional implants [6,7]. In the present case, implants in lengths of 9 and 7.3 mm were used. The design of the iSy Implant System combines the typical features that characterize a state-of-the-art implant system: a conical inner connection, an RTTT (rough-to-the-top) surface, and an implant-abutment transition with platform switching. It should be noted here that an “RTTT” surface, which dispenses with a machined implant neck, requires epi- to subcrestal positioning with platform switching. If a thick gingival cuff and thus a deep subgingival implant position prevails, then sensible soft tissue management is of great importance for the prosthetic success [5]. Here, the iSy System offers various options for shaping and optimizing the emergence profile: one option is the fabrication of implant-supported temporary restoraFig. 28: The CAD design of the zirconium oxide bridge framework. Fig. 32: The inserted bridge after the X-ray check (orthopantomogram). Fig. 31: The implant bridge 43–46 in situ after checking the esthetics and function. Fig. 30: Detailed view of the anatomically shaped individual ceramic abutments bonded to iSy Implant bases with mounted model analogs. Fig. 29: The zirconium bridge was veneered individually with the corresponding zirconium ceramics. MDT Florian Kubitschek, GL Dental, Penzberg. CASE STUDY
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