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logo 50 | the Camlog Partner Magazine logo 50 | the Camlog Partner Magazine 14 | Case study Case study | 15 Dr. Maximilian Wienke Dentist Krestales Verankerungsgewinde Sägezahngewinde mit verbreiterter Flankenhöhe Konischer Bereich Promote®plus Oberfläche Parallelwandiger Bereich Gewinde bis zum Apex Für zusätzlichen Halt bei begrenzter Knochenhöhe2 Tief eingreifende Gewindeflanken Optimierte Verteilung axialer Kräfte1 Gezielte Knochenkompression1 Exzellente Primärstabilität Reduzierter Durchmesser in Bereichen mit wenig Knochen 1,2 Bewährte gestrahlte, säuregeätzte Oberfläche Ideal für Sofortimplantationen1,2 Kontur Formbohrer PROGRESSIVE-LINE CONELOG® PROGRESSIVE-LINE Implantat COMFOUR® in the edentulous jaw- a patient-centric solution also for patients with dental anxiety PRACTICE The etiology of dental anxiety, fear, or phobia is complex and multifactorial [2]. In the current S3 guideline [3], dental anxiety is interpreted "as an intense emotional reaction to elements of the dental treatment situation which causes suffering for the person affected and which appears excessive in view of the actual dangers in the situation." Nevertheless, such patients are more likely to accept intraoral defects and the risks of organic sequelae instead of necessary treatment. This is accompanied by social withdrawal, as people are ashamed of their supposedly poor tooth structure. Only when the pain becomes unbearable is a dentist consulted. Various studies suggest to openly address these obvious fears in such patients even before treatment begins, to allow them to participate in the therapy decision and give them the opportunity to influence treatment. In this context, empathy of the entire treatment team, free of prejudice and reproach, plays a decisive role for sustained therapeutic success with a permanent commitment to compliance on the part of the patient, as well as for long-term patient loyalty. Even patients suffering from "dental anxiety with a disease status" generally show good follow-up behavior after successful therapy, which is comparable to non-sufferers. This positive development can be reinforced by good communication skills and a treatment team trained in dealing with anxious patients. In the present case, the 50-year-old female patient had avoided making dental appointments for years due to her "dental phobia". However, her physical and psychological suffering had meanwhile increased to such an extent that therapy became unavoidable. On the one hand, her greatest wish was to be able to "laugh carefree and chew without pain" again as quickly as possible. On the other, there were strong reservations about augmentative interventions and a limitation on the part of the costs. The COMFOUR method succeeds in reconciling both aspects. Workflow The various treatment options available after the necessary extraction of all remaining teeth were discussed in great detail with the patient during the preliminary consultation, taking into account possible consequences, and the anticipated course of treatment was described to her in detail. In this context, the patient's desire for fixed dentures became apparent based on her painful experiences with her massively dysfunctional dentition. After assessing the various aspects, the patient opted for a restoration in the upper and lower jaw on four implants each using the COMFOUR method. In this technique, the distal implants are placed in an angled position to achieve sufficient stability even in a vertically reduced alveolar ridge without augmentation. For the patient, this procedure offered the advantage that extraction, implant placement and interim restoration could be performed painlessly under intubation anesthesia within a single day. » The primary focus of implant therapy in the edentulous jaw is the patient's satisfaction with the course of therapy. Due to the clinical and time requirements as well as the cost burden, treatment concepts with extensive augmentative measures entail the risk that the patient will switch to alternative restorations, which may, however, bear certain risks from a longer-term perspective. For example, pressure exerted by the denture can cause incorrect loading of the jawbone and lead to bone loss over the course of time. In contrast, bone recession does not occur with implant-supported restorations. Here, the COMFOUR concept with distally angled implants offers a convincing solution which is also patient-oriented in terms of cost. It generates an esthetic and long-term stable result with reduced invasiveness, less surgical effort and shorter treatment times. Sandra Kirchmaier Dental technician 1. Clinical examination of the initial situation had already revealed the desolate intraoral situation with root remnants, destroyed crowns, posterior tooth losses in four quadrants, massive calcified deposits (calculus) on all remaining teeth, as well as severely inflamed soft tissue. 3. Following extraction of the residual dentition, the site was disinfected by means of antimicrobial photodynamic therapy (aPDT) and four 3.8 mm Conelog® Progressive-Line implants were inserted via SMOP drilling templates. While the implants in the upper jaw healed under a covered implant denture due to the soft bone substance, the lower jaw was immediately restored with an interim denture. 5. Scans of the initial situation and printed situation models formed the basis for the further digital workflow, such as a slotted mandibular orientation template for rechecking the alignment of the implants as well as a prefabricated full denture made of a milled dental arch and manually applied pink plastic as interim restoration of the upper jaw. 2. The X-ray confirmed the impression gained during clinical examination. The massive loss of hard tissue made any form of tooth preservation impossible and demonstrated the necessity of extracting the tooth fragments as well as the remaining teeth in a manner that was also comprehensible for the patient. 4. The Progressive-Line® Implant with its typical sawtooth thread and deeply engaging thread flanks compresses the soft bone and optimally distributes axially acting forces. Due to the conically tapered apex, insertion is also possible in sites with reduced bone volume. 6. X-ray control image of the titanium caps screw-retained on the distally 30 degree angled COMFOUR bar abutments (for the bar abutment for bridges) for retention of the interim temporary in the lower jaw.