logo 18 • CAMLOG Partner Magazine • July 2018 20 Fig. 19: Intraoral view of the denture in the upper jaw with gold inlay. Fig. 20: Extraoral view of the prosthesis with customized tooth position. Fig. 21: Extraoral view of the prosthesis with incorporated gold inlay. position after three months (Fig. 14) (Ø 5.0 mm / L 13 mm or Ø 4.3 mm / L 11mm). Five temporary implants (IPI´s) were used to support the interim prosthesis (Fig. 15). The implants were exposed after approximately six months, the interim implants were removed and gingiva formers were inserted. To compensate for the vestibular gingival deficit, the palatal soft tissue was moved buccally and the ridge incision was sutured. Open gap areas healed secondary and led to a dense peri-implant cuff (Fig. 16). The definitive denture The final prosthesis was fabricated four weeks after exposure. After registration and impression taking, the dental technician created an esthetic and functional set-up. Based on this, primary telescopes were made of zirconium oxide on the titanium bases CAD/CAM. The secondary telescopes and the framework were milled from the high-performance plastic PEEK using the CAD/CAM process. PEEK is break-resistant, has good sliding properties and is not susceptible to plaque. (Figs. 17 and 18). The ceramic abutments and customized design of the telescope-supported dental prosthesis offered the best static, functional and esthetic conditions for patient satisfaction and hygiene capability (Fig. 19). The extraoral view shows the advantages of the customized design up to the incorporation of a gold inlay in region 24 at the request of the patient, which does not have the negative appearance of conventional prostheses due to the very stable anchorage and palate-free design (Figs. 20 and 21). Discussion In addition to the free-end situation, the edentulous upper jaw offers the most frequent indication for horizontal and vertical bone augmentation. In the frontolateral segment of 14-24, a horizontal augmentation is usually necessary to counteract the dorsal position of the alveolar ridge. In the molar region, on the other hand, a sinus lift is necessary in order to achieve a sufficient vertical dimension due to the extension of the maxillary sinus. An absolute vertical abutment is rarely required here, at best in the case of large differences between crown and implant lengths due to bony step formation, typically in interdental gaps or free-end situations. This case shows this problem in an ideal way and leads to an attractive result, which takes into account the forward displacement of the anterior teeth through horizontal augmentation as well as the sufficient implant length in the molar region through a lateral sinus lift. The restoration with ceramic abutments leads to irritation-free gingival healing and a very stable prosthetic restoration. There are almost no limits to the degree of customization, as the steep tooth position and inlay insert show. Neither sinus lift nor frontolateral augmentation require alternative methods such as iliac crest / tibia removal or foil techniques as long as the graft size from retromolar is sufficient. Fig. 13: Digital volume tomography (DVT) for pre-implantation measurement: face views, visible bone grafts and mini screws. Fig. 15: X-ray control by orthopantomogram (OPT) after implantation: five temporary implants (IPI´s) in situ to support the prosthesis. Fig. 14: Intraoperative status after implantation in the maxilla with insertion post in situ (mirror image). CASE STUDY
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