logo 19 • CAMLOG Partner Magazine • December 2018 21 Fig. 20: The occlusal view of the superstructure according to the prosthetic requirements. Fig. 19: Clinical situation after 2 years. The reconstructed area region 26 with prosthetic in situ from lateral. The peri-implant soft tissue is free of irritation. Fig. 14: The mesh is filled with augmentation material from autologous bone and bone substitute material (Bio Oss 1-2 mm, Geistlich Pharma) and inserted. Fig. 15: Mesio-lateral view of the screwretained titanium mesh with slightly compressed augmentation material in situ. Fig. 13: Insertion of the CAMLOG SCREW-LINE Implant (Ø 5.0, L 11 mm), in the pre-planned position. The upper, non-anchored convolutions of the implant are completely covered by augmentation material. treatment. The superstructure was integrated here on 5.9.2016. Results Radiographic follow-up 26 months after surgery showed a stable augmented vertical bone level (Fig. 18). Similarly, peri-implant soft tissue conditions presented free of clinical irritation and scarring and without dehiscent areas. The superstructure met all prosthetic and esthetic requirements (Figs. 19 and 20). Discussion The cosmetic and above all functional situation after tooth loss in region 26 was to be improved by closing the gap. A conventional prosthetic restoration (bridge 25-27) would have been an alternative treatment option to the performed implant insertion. In doing so, the abutment teeth 25 and 27, which did not require therapy, would have been affected by the preparation. In this case, implantation offered the option of closing the existing gap and preserving healthy tooth substance. The bone augmentation required in this instance has proven to be successful for single tooth replacement. Predictable results can be achieved in terms of augmentation and implant survival [14]. Equal survival rates in native and augmented bone have been determined for an additive procedure using the onlay technique – similar to the present case [15]. Augmentation was performed using a CAD-CAM fabricated customized titanium mesh. Bone reconstructions using titanium meshes were first described by Boyne in 1969 (16). Vertical and horizontal augmentation with titanium meshes is meanwhile regarded as being efficient [17, 18]; also particularly for the upper jaw [19]. This also applies to single-stage application in connection with implantations and augmentations as in this case [20]. Studies with customized titanium meshes have shown significant success in jaw reconstruction and in connection with implantations [5, 6, 21]. One study reported a 100% success rate for augmentations performed with customized titanium meshes [7]. Shortened intervention times were described, and this also applied to the present case. It was also possible to individually adapt the intervention in advance through three-dimensional planning. Thus the mesh could be designed and printed specifically for the patient. Digital implantation was planned according to the prosthetic specifications and additional sinus lift surgery was avoided. The final outcome confirmed this planning and the use of the patientspecific mesh. Resorption that occurs after 6 months with the combined use of bone graft substitute and autologous bone in conjunction with a sinus lift was thus excluded [22]. Alternatively, conventional block augmentation from intra- and extraoral donor sites could have been performed. Increased co-morbidity for the patient would have been the consequence. The possibility of reduced revascularization and melting of part of the volume would also have existed [23]. The use of allogeneic blocks was rejected by both the clinician and the patient. Due to the greatly reduced bone at the implant site, other options for vertical bone augmentation such as distraction osteogenesis or interposition plasty were not considered. CASE STUDY
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