logo 49 | The Camlog Partner Magazine 12 | Case study Digital dentistry intelligently combined with analog craftsmanship PRACTICE CASE Even in a digital age, the decision about the type and scope of restoration is a very personal one and is determined by the patient. Our task is to provide them with all the information they need and to share our knowledge to enable them to make this decision in a self-reflective manner. Every patient is unique and each treatment plan must be tailored to the individual patient's wishes, but also to the patient's anatomical conditions and compliance. When the only tool available is a hammer, then every problem looks like a nail, however, patients should be approached with a well-stocked toolbox. It is incorrect to claim that every periodontally damaged dentition precludes an immediate restoration on 6 implants. After all, our goal is to preserve teeth and, together with the patient, to exhaust all conservative options. The patient in the following case was 82 years old at the time of initial presentation and was still very active both mentally and physically. He goes skiing several times a year, is an enthusiastic hiker and also actively participates in the grape harvest every year. He complained of highly mobile teeth in the upper jaw which would make painless chewing increasingly difficult. A removable denture was unthinkable for him, and he also wanted to avoid palatal coverage under all circumstances. The concept of immediate prosthetic restoration with implants is basically nothing new. However, this has been greatly facilitated in many of the work steps in recent years through digital planning and production options. As a result, even comprehensive work can be precisely planned, as well as being fabricated cost-effectively and therefore made accessible to a broader patient clientele. The restoration options for existing or impending edentulism must be discussed in great detail. These range from removable dentures, both on Locator abutments as well as on galvano telescopes, to screw-retained fixed implant restorations. They depend very much on patient compliance, motor skills as well as patient preferences. Given the fact that complex alveolar ridge reconstructions are sometimes difficult to design in advanced age, as they often lead to postoperative complaints and prolonged treatment times, the screw-retained solution with the COMFOUR abutment system is recommended for older edentulous patients in the author's practice concept. Its implementation meets the wishes of many patients: usually only one surgical procedure, a short treatment period, no complex augmentative measures and a modest financial outlay. With fixed occlusal screw-retained bridges on four or more implants, augmentation measures can be largely dispensed with due to the option of inserting implants at an angle. Digital imaging capabilities [1] are a prerequisite for the implementation of the concept. They not only facilitate planning, but also patient education. Even before a tooth is extracted, the patient can view his future dental prosthesis using the digital display options. Based on the 3D planning, the temporary restoration is fabricated pre-surgically, either in the laboratory or by a manufacturing service provider, so that the patient leaves the practice after the procedure with a fixed screw-retained but temporary prosthesis. With foresighted planning and exact implementation, such immediate loading concepts, which make optimum use of the available bone volume, are comfortable, economical and low-risk restoration options. » Dentistry is and remains a tangible and craft-based discipline, which has always utilized the latest production techniques, processes and high-quality materials. For many decades, the dental workflow in particular was dominated by materials such as wax, plaster and cast metal. If one exploits the potential of today's dentistry, then very precise plans can be created on the digital model, which visualizes all the treatment phases ranging from surgery through to prosthetic restoration. Implementation, too, can also be accomplished in a precise and targeted manner by applying modern CAD/CAM processes together with the dental laboratory and the industry. Dr. Maximilian Blume Oral surgeon
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