logo 18 • CAMLOG Partner Magazine • July 2018 22 Dr. Dominik Emmerich, Ravensburg IMMEDIATE FIXED REHABILITATION THE RESTORATION OF EDENTULOUS JAWS WITH THE AID OF A MODIFIED PRACTICE CONCEPT Fig. 1: The site of an insufficient mandibular bridge restoration. Immediate strong teeth is an increasingly frequent request of patients after multiple loss of their own teeth. In addition, there are demands for cost-efficient care in as few treatment sessions as possible. In the present case, an own concept from our practice with a special template technique for immediate restoration of the mandible after extraction of the teeth unsuitable for preservation is presented. The reconstruction of edentulous jaws with implants through immediate restoration is a well-founded treatment option in geroprosthetics [1]. Fixed, occlusally screw-retained bridges on four or more implants, a concept made popular by Professor Paolo Maló, are becoming increasingly favored by edentulous patients [2;3]. The prerequisite for immediate restoration is primary stable anchoring (30 Ncm) of at least three implants. In our practice concept we have integrated the therapy option of a fixed prosthetic reconstruction on at least four implants [4] and tried to reduce the treatment appointments to a minimum in accordance with the wishes of many patients. With the aid of a combined bite registration/impression tray, a long-term temporary restoration with immediate loading within 12 hours and/or a definitive composite bridge in the sense of early loading within 14 days [5] is possible due to the splinting of the impression posts. If a metal or all-ceramic restoration is desired, the final restoration is fabricated after approximately three months of implant healing and healing of the soft tissue. If the primary stability on at least three implants is not 30 Ncm or other risk factors such as bruxism are present, the final prosthesis is not integrated until after the implant has healed. As the postoperative impression is taken with splinted impression posts, the master cast created can be used to fabricate both the temporary and the final denture. Case presentation, planning and decision on therapy A 64-year-old female patient presented in our practice with a marginal periodontitis profunda and a prosthetically insufficiently restored set of dentures (Fig. 1). In a consultation regarding the therapy options for prosthetic restoration, she stated that she would only consider a fixed denture in the lower jaw. The upper jaw should first be treated with a new full denture and later also with implants. Despite being informed about the possibility of preserving most residual mandibular teeth (root canal treatment on 44, closed PA, open PA on all teeth with residual pockets > 4 mm, apical displacement flaps with osteoplasty on at least 34 and 35 and possibly regenerative PA treatment on 44 and 45), her wish was a purely implant-supported reconstruction, as she had lost confidence in her own teeth (Fig. 2). Being an anxious patient, she was looking for a therapy option to receive a definitive, fixed denture in as few sessions as possible. The patient stressed that she never wanted to leave the practice without teeth. To verify the possibility of immediate implant placement with immediate restoration, the patient decided to have a digital volume tomography and clarification of the three-dimensional bone offer performed during her first visit to our practice: A sufficient ridge width could be achieved by resection of the ridge. The bone height above the mental foramen was more than six millimeters (Figs. 3 and 4). Fig. 3: Digital volume tomography to evaluate bone height and thickness. CASE STUDY Fig. 2: The radiographic representation of the initial situation.
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