Partner Magazine logo 18 – July 2018

logo 18 • CAMLOG Partner Magazine • July 2018 26 Wound control and insertion of the final denture (sessions 4 and 5) After a wound and bite check on the first postoperative day, the final metalplastic bridge (15 Ncm) could be inserted together with the suture removal after 14 days. Due to the good bite situation on the one-day check, it was not necessary to take fine bite impressions on the metal framework before completion (Figs. 23 to 27). After approximately three months, the patient received her first professional implant cleaning with removal of the twelve-pontic metal-reinforced plastic bridge. The abutments were checked and retightened to a full 30 Ncm. No bite correction through reassembly or relining of the bridge was necessary for the patient. The length of the bridge pontics and cleaning supports was chosen to allow a mucosa thickness of approx. 2-3 mm over the resected alveolar ridge. With epi- to subcrestal positioning of the implant shoulder and known abutment height, this could be readily estimated by the dental technician. An evenly leveled alveolar ridge is advantageous for a good basal fit of the bridge (see Figs. 14, 22 and 25). Discussion Definitively screw-retained bridges with composite veneers or acrylic teeth on four implants are less expensive and more patient-friendly than the removable cast model-reinforced reconstruction on four implants with bars or telescopes [2;3]. The All-on-X therapy concept is an excellent and cost-efficient alternative in my practice for many edentulous patients or patients with a hopeless residual dentition [6]. Appropriate implantological and prosthetic experience is a prerequisite for this type of treatment. In accordance with the Maló concept, a freehand implantation is performed in the region of the premolars and anterior teeth with full flap formation. A classic drilling template or navigation template is dispensed with. This allows the clinician to adjust the implant position and axis within certain limits according to the intraoperative conditions, which can often change unplanned due to the immediately preceding extraction of teeth, granulation tissue and, if applicable, (apical) cysts. Intraoperatively, the surgeon has greater freedom to resort to a wider implant diameter if the primary stability is too low. This is more often the case in the upper jaw due to the lower bone quality. Therefore, the implant bed should always be underprepared in the upper jawand, if necessary, bone condensing should be performed, no tapping and, if applicable, no trial screwed insertion of the implants. The conical outer geometry of the CONELOG® Implants and the possibility of placing the CONELOG® Implants epicrestally up to 1 mm subcrestally facilitate the adjustment of good primary stability. An enormous advantage is the absolutely identical inner geometry and interchangeability of the abutments and titanium caps (for impression taking) of the CONELOG® Implants with 3.8 mm and 4.3 mm diameters. This allows a free choice Fig. 26: The occlusion check of the bridge after sealing the screw access channels. Fig. 24: The X-ray control image with the definitively inserted restoration 14 days after surgery. Fig. 27: The final picture: satisfied patient, cost- and time-efficient treatment. Fig. 25: Owing to the combined impression tray and exact bite registration, there is no need for reassembly. Fig. 23: The inserted lower mandibular restoration from occlusal. CASE STUDY