logo 19 • CAMLOG Partner Magazine • December 2018 8 was left temporarily and incorporated into the temporary restoration. Using two Locators® screwed onto the two Lodi implants, the interim prosthesis could be secured securely and reliably to protect the definitive implants (Figs. 16 and 17). Implantological restoration in the lower jaw In terms of restoration of the lower jaw, it was decided to combine extraction of the teeth not worthy of preservation with immediate implant placement and a fixed temporary immediate restoration. After tooth extraction, four CAMLOG SCREW-LINE Implants (region 35, 33, 43 Ø 4.3 mm/L 11 mm, region 45 Ø 4.3 mm/L 9 mm) were inserted with primary stability. Next, straight COMFOUR® Bar abutments were placed on the four implants (Fig. 18). For temporary immediate restoration, we screwed the titanium caps onto the bar abutments without a rotation lock (Fig. 19). To prevent the polymer from flowing into the screw access channels of the titanium caps when bonding the acrylic bridge fabricated beforehand, we sealed them with wax prior to polymerization. After intraoral “bonding”, the bridge was removed and the excess acrylic was removed from the bonding areas, the transitions were carefully finished and polished (Figs. 20 and 21). After insertion, the construction was checked for a tension-free fit and cleanability. Exposure of the implants in the upper jaw After a healing period of four months, the six implants in the upper jaw were exposed. In the first quadrant, exposure of the implants was combined with soft tissue augmentation to improve the thin gingival situation of the implant in region 13. Volume augmentation of the peri-implant gingiva was achieved with a palatally reinforced connective tissue graft (Figs. 22 to 24). In the second quadrant, the volume of peri-implant gingiva was found to be adequate. However, keratinization of the peri-implant gingiva was insufficient in the area of the implant in region 23. A zone of keratinized gingiva was achieved buccally to the implants using an apical displacement flap (Figs. 25 and 26). Impression taking and bite registration of the implants The primary impression of the implants was taken 8 weeks after exposure at implant level using impression posts for the closed impression and a prefabricated impression tray (Figs. 27 and 28). Two registration templates were fixed to the sulcus formers to determine the bite registration. The esthetic and functional criteria such as the dental center, the canine lines and the maximum smile line were defined and marked in the wax wall. The bite height was taken from the temporary prosthesis. Registration material applied to the templates encoded the bite registration (Fig. 29). Facebow registration was used for extraoral registration. Intraoral bonding – pick-up impression In the laboratory, the models were fabricated and a complete diagnostic setup was implemented in wax. A wax try-in is indispensable to ensure a functionally ideal and esthetically appealing prosthetic Fig. 17: The interim restoration was fixed via locators that had previously been screwed onto the LODI implants. Fig. 16: The soft tissue was sutured salivaproof and tension-free. Fig. 18: In the lower jaw, the remaining teeth were extracted, four CAMLOG SCREW-LINE Implants were placed and COMFOUR Bar abutments screwed in. CASE STUDY Fig. 22: The implants in the upper jaw were exposed via crestal incision. Fig. 23: To improve the soft tissue volume in region 13, a palatally reinforced graft was inserted. Fig. 24: Single button sutures were used to close the soft tissue around the screw-retained gingiva formers.
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