logo 18 • CAMLOG Partner Magazine • July 2018 24 the impression/bite registration tray. The COMFOUR® Aligning tools were used to check the direction of a groove in the CONELOG® inner connection in order to optimally position the angled COMFOUR® Abutments. The aligning tool also served the defined position of the screw access channel in the prosthesis (Figs. 8 and 9). Then one implant was placed centrally in region 31/41 and one implant each in regions 33 and 43. Straight COMFOUR® Abutments were screwed onto the anterior implants. All implants could be inserted with a primary stability greater than 30 Ncm. Using the flexible pre-mounted insertion aid, the 30° angled abutments were placed on the distal implants and screw-retained in the implant with the abutment screw and a defined torque of 20 (angled) and 30 Ncm (straight). (Figs 10 to 14). The healing caps were placed on the abutments and the mobilized mucoperiosteal flap was sutured tightly (Fig. 15). The healing caps were removed after completion of the suture, replaced by the plastic-coated titanium caps (impression posts) and tightened with 10 to 15 Ncm. A control X-ray image ensured the exact fit of the impression posts without trapping any parts of the mucosa (Figs. 16 and 17). For impression taking, a rubber dam was cut out in aU-shape, disinfected andplaced over the surgical field. The titanium caps were splinted with Pattern Resin to ensure a tension-free fit for the temporary and final restoration (Fig. 18). The duplicated, transparent maxillary prosthesis was inserted. Prior to impression taking/bite registration, the combined impression and bite registration tray of the mandible was checked. The mandibular tray had to be fixed securely to the maxillary transparent prosthesis with the colored bites and rest on the mucosa in the range of the 6 to 8 (vertical stop for bite registration) (Fig. 19). The opening and closing of the mouth for bite registration was practiced several times with the still partially sedated patient. Here, the clinician fixated the combined impression and bite registration tray together with the maxillary transparent prosthesis to the upper jaw with the left hand and guided the lower jaw with the impression posts in a jaw-locking movement to the vertical stops of region 38 to 36 and 46 to 48 with the right hand (manual bite registration). Interference contacts of the impression posts on the maxillary transparent prosthesis could be removed liberally. The individual mandibular tray was now filled with impression material (Monopren/Kettenbach), placed on the maxillary transparent prosthesis and the patient guided into RCP with pressurefree hand bite registration. It is of utmost importance in this procedure that the lower jaw is not opened until the impression has set (Fig. 20). Therefore, good nasal breathing must be ensured before the procedure. After the impression material cured, the screws were cut free and unscrewed from the abutments. The impression tray was removed and checked: the splinted titanium caps were fixed in the material in a stable position and the tray in region 38 to 36 and 46 to 48 was pressed through evenly and thinly (Fig. 21). The COMFOUR® Healing caps were screw-retained again until the temporary restoration was inserted. Fig. 14: Three straight and two angled COMFOUR® Abutments were used. Fig. 15: The soft tissue was sutured around the screw-retained gingiva formers. Fig. 16: The plastic-coated impression posts were screw-retained and the approximal contact freedom was checked. CASE STUDY Fig. 10: The 30° angled CONELOG® COMFOUR® Abutment with the pre-assembled flexible handle. Fig. 9: The aligning tool is used for optimal positioning of the angled COMFOUR® Abutments. Fig. 8: The practice concept for immediate restoration includes an additional centrally placed implant.
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