logo 19 • CAMLOG Partner Magazine • December 2018 19 to a perio-endo lesion with buccal fistula and putrid secretion. The results for circular pocket depth measurement were 6/10/10/10/12/4. The adjacent teeth were vital and not periodontally damaged. As a future restoration, the patient wanted a fixed, implant-prosthetic rehabilitation with a single-tooth crown. The patient rejected a conventional bridge restoration as a treatment alternative. The patient was in the professional dental cleaning recall program of the referring family dentist’s office. Atraumatic extraction on 06.02.2015 resulted in an interdental gap with threedimensional; largely vertical, bone deficit (Fig.2). The patient was provided with a temporary restoration by her family dentist using a Walplast interim prosthesis. In situ, the soft tissue situation presented itself free of irritation and without scars (Fig.3). Planning In addition to clinical diagnostics, digital volume tomography (DVT) was performed as the basis for further implantological therapy. The bone defect was also pronounced (Fig.4), so that transversal and vertical augmentation had to be planned. This was to be realized by means of an individually fabricated titanium mesh. A one-stage procedure was planned. Compensation of the volume deficit was to be purely additive in the direction of the oral cavity for the later prosthetic restoration; a sinus lift as well as a two-stage procedure were to be avoided (Fig.5). On the one hand, insertion of the customized mesh over the implant would lend itself to avoiding mechanical stress during bone healing. On the other hand, the required augmentation volume would be fixated. A slight overcontouring of the defect was also to be performed. A digital 3D model of the defect was created with the DICOM data (Digital Imaging and Communications in Medicine) of the DVT. Based on the virtual model, a patient-specific mesh (Yxoss®, ReOSS) was designed (Figs. 6 and 7), which was printed in 3D after consultation with the clinician (Figs. 8 and 9). In addition, a virtual and analog model analysis was performed. An analog set-up of tooth 26 was performed to determine the three-dimensional position of the implant. To this end, an X-ray splint was fabricated for precise virtual planning. This could later be used as a surgical splint. Surgical technique A slightly palatally displaced incision was performed in region 25-28 under local anesthesia (Ultracain DS Forte, Hoechst, Germany). This was performed Fig. 4: The virtual 3D model for implantological planning confirms the defect situation. As an additional finding, a restapical ostitis is recognizable in tooth 24. Fig. 5: Planning of the correct implant position according to the prosthetically harmonious implant-to-crown ratio and the required augmentation area. Fig. 6: 3D presentation of the planned mesh from lateral on the basis of the DICOM data set. CASE STUDY Fig. 7: The 3D representation from occlusal. Fig. 9: 3D-printed titanium mesh (Yxoss CBR, ReOSS, Filderstadt) from basal after sterilization. Fig. 8: 3D-printed titanium mesh (Yxoss CBR, ReOSS, Filderstadt) from lateral after sterilization.
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