logo 18 • CAMLOG Partner Magazine • July 2018 27 between these two implant diameters intraoperatively. This is a great advantage in the case of relevant intraoperative processes or necessary deviations from planning. In the rare case that a 5.0 mm implant is required for sufficient primary stability, this is kept available as a rescue implant together with a straight, a 17° and a 30° angled abutment. If a fixed navigation template is used, a framework-free all-resin temporary restoration can be fabricated preoperatively. Whereby it should be noted that the implant cannot be screwed in deeper if primary stability is poor. This is one reason for the insertion of one or two additional implants. After the surgical procedure, the sleeves are screwed onto the abutments and polymerized intraorally in occlusion with the opposing jaw into the temporary restoration. Disadvantages of using navigation templates with preoperatively fabricated immediate temporary restorations are that the alveolar ridge cannot be leveled to achieve a correspondingly wide ridge, the implants cannot be set deeper with low primary stability and the angle of the distal implants is limited to 30°. If all requirements for the navigation technique are met, then it is faster and easier to use. A tension-free fit of the restoration is necessary to provide a high success rate with immediate loading. In the author's opinion, the splinting of the impression posts is therefore of great importance. Tension can also occur at the interface between the implant and abutment if the alveolar ridge distal to the angled implants is not sufficiently reduced and the abutment rests on the cortical bone. If the implants are angled more than 30°, this aspect must be taken into account. We have been treating according to this concept in our practice for ten years, whereby in the early years only temporary all-plastic bridges were incorporated for the healing period. The absence of implant losses encouraged us to integrate definitive metal-plastic bridges after two weeks. If a metal or all-ceramic bridge is required, it is always fabricated after the implants have healed. For early restoration with a definitive bridge, relining is necessary in 2/3 of cases and reassembly in less than 1/3 of cases after implant healing. Due to the precise impression technique, the original master casts can always be used for the reassembly or fabrication of the final denture. Owing to the high accuracy of bite registration with correct use of the described technique, with appropriate surgical and prosthetic experience, combined with the required primary stability of 30 Ncm, the final denture can be integrated as a so-called early restoration. According to the author's experience, controlling the torque with the torque wrench is completely sufficient. [1] Ledermann, P., D.: Über 20-jährige Erfahrung mit der sofortigen funktionellen Belastung von Implantatstegen in der Regio interforaminalis.Z Zahnärztl Implantol 12, 123–136 (1996). [2] Malo P, de Araujo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc 2011;142:310–320. [3] Maló P, Rangert B, Nobre M. „All-on-Four“ immediate-function concept with Brånemark System implants for completely edentulous mandibles: a restrospective clinical study. Clin Implant Dent Relat Res. 2003;5 Suppl 1:2-9] [4] Kern JS, Kern T, Wolfart S, Heussen N. A systematic review and meta-analysis of removable and fixed implant-supported prostheses in edentulous jaws: post-loading implant loss. Clin Oral Implants Res. 2016;27(2):174–95 [5] Weber HP, Morton D, Gallucci GO, Roccuzzo M, Cordaro L, Grutter L. Consensus statements and recommended clinical procedures regarding loading protocols. Int J Oral Maxillofac Implants. 2009;24 Suppl:180-3 [6] Babbush CA, Kanawati A, Kotsakis GA, Hinrichs JE. Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study. Implant Dent 2014;23(2):218-24 LITERATURE AUTHOR Dr. Dominik Emmerich Dr. Dominik Emmerich studied at the Albert-Ludwig-University Freiburg from 1994 and graduated in 1999. Until 2004 he worked as a scientific assistant in the Department of Dental Prosthetics under Professor Strub at the Klinikum Freiburg. In 2002, Dr. Emmerich received his doctorate on the topic of hard and soft tissue reactions on titanium implants. From 2004 to 2008 he worked in the Department of Oral and Maxillofacial Surgery at the University Hospital of Freiburg with Professor Schmelzeisen. After being appointed specialist for oral surgery and specialization in implant dentistry, he moved to the joint practice with Dr. Julia Emmerich in Ravensburg in 2008. Dr. Emmerich is a member of the New Group and the associations DGZMK, DGPro, DGI, BDO, BDIZ and EDI. Contact details Dr. Emmerich² and Colleagues Dr. Dominik Emmerich Specialist in oral surgery Specialist for implant dentistry (BDIZ/EDI) Specialist for dental prosthetics and biomaterials (DGPro) Practice Clinic for Dentistry Parkstraße 25 88212 Ravensburg info@emmerich-emmerich.de CASE STUDY
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