logo 19 • CAMLOG Partner Magazine • December 2018 6 Dr. Eleftherios Grizas, Dogern COMPLEX REHABILITATION USING IMPLANT-SUPPORTED TELESCOPE CONSTRUCTIONS Fig. 1: Initial clinical findings of the fixed reconstruction after 25 years in situ. In addition to restoring chewing function and chewing comfort, the focus of a complete dental restoration is on taking esthetic and phonetic factors into consideration. Furthermore, risk factors for both technical as well as biological complications should be minimized as far as possible. This case report describes how a practice concept for functional and esthetic implant-supported rehabilitation can be developed and therapeutically implemented through consistent planning. Initial situation The 48-year-old patient presented in the practice with the wish for a new complete restoration of her dentition (Figs. 1 to 3). According to the patient, the existing fixed reconstructions have been in situ for over 25 years. Due to multilocal secondary caries and chipped veneers, the existing restoration was classified as being insufficient. The X-ray revealed generalized horizontal bone resorption to a medium degree as well as multiple apical osteolysis zones (Fig. 4). There were no functional complaints. The patient wished for an esthetic, functional and long-lasting restoration of the upper and lower jaw. There were no known general medical disorders and she was a non-smoker. Due to the numerous lesions, it was decided to perform extensive surgical reconstruction and to realize rehabilitation with a purely implant-supported restoration using double crowns. To keep the duration of treatment as short as possible and also to maintain the patient’s accustomed chewing comfort during the healing period, immediate implant placement with an immediate temporary restoration was to be aimed for. Implantological restoration in the upper jaw The three-dimensional X-ray examination showed that placement of the implant in the upper jaw would only be possible with bilateral bone augmentation in the sense of an external sinus lift on both sides. After extraction of the teeth, a mucoperiosteal flap was prepared to expose the lateral wall of the maxillary sinus. To gain access to the sinus, a bone cover was prepared osteoplastically using piezo surgery (Figs. 5 and 6). The Schneider’s membrane was then shifted cranially until the medial maxillary sinus wall was exposed (Fig. 7). A Mem-Lok collagen membrane (BioHorizons®) was inserted to stabilize the elevated mucosa (Fig. 8). The prepared bone bed was filled with MinerOss® XP Cancellous (BioHorizons) (Fig. 9). The bone cover was repositioned and fixed in the opening to give a precise fit (Fig. 10). A total of six CAMLOG® SCREW-LINE Implants (region 15, 14, 24, 25 Ø 4.3 mm/L 11 mm, region 13, 23 Ø 4.3 mm/L 13 mm) were inserted (Fig. 11). To protect the implants during the healing phase, we decided to use two LODI® implants in region 12 and 22 (Ø 2.9 mm/L 10 mm) for the stable anchoring of the interim restoration (Figs. 12 and 13). Within the context of lateral augmentation, existing bone deficits were reconstructed using Mem-Lok® and MinerOss XP Cancellous (Figs. 14 and 15). For submerged healing, the soft tissue was closed saliva-proof over the CAMLOG SCREW-LINE Implants. Tooth 16 CASE STUDY Fig. 2: The insufficient restoration in the upper jaw with a unilateral free-end situation. Fig. 3: The lower jaw presented with multiple acrylic chipping of the cemented gold bridges.
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