logo 50 | the Camlog Partner Magazine logo 50 | the Camlog Partner Magazine 18 | Case study Case study | 19 19. The sintered crowns were personalized with stains and bonded in blocks of three to the opaque frameworks according to the manufacturer's processing instructions, after having previously visualized their surface structures with texture powder for esthetic optimization. 20. After layering and characterizing the soft tissue structures with pink composite, the optical impression of natural single crowns was created as intended and hoped for by the patient. 21. and 22. The finalized superstructures for the upper and lower jaw in situ and in the X-ray control image after their final insertion. Final photos of the visibly relieved patient. Even though the lip and cheek appearance may not meet esthetic ideals, it still reflects the patient's regained individuality and self-confidence. [1] Bayer G, Kistler F, Kistler S, Sigmund F, Adler S, Neugebauer J. Versorgungsmöglichkeiten ohne Sinusbodenelevation mit angulierten Implantaten - 6 Jahre Erfahrungen. Implantologie 2012;20:195–204. [2] Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295-301. [3] DGZMK. S3-Leitlinie Zahnbehandlungsangst beim Erwachsenen (Langfassung) AWMF-Registernummer 083-020, Stand 31.10.2019, Internet: register.awmf.org/de/leitlinien/ detail/083-0209. [4] Malo P, Rangert B, Nobre M. „All-on-Four“ immediate function concept with Branemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res 2003;5(Suppl 1):2–9. [5] Tallarico M, Canullo L, Pisano M, Penarrocha-Oltra D, Penarrocha-Diago M, Meloni AM. An up to 7-Year Retrospective Analysis of Biologic and Technical Complication With the All-on-4 Concept. J Oral Implantol 2016;42(3):265–271. [6] Tallarico M, Meloni SM, Canullo L, Caneva M, Polizzi G. Five-Year Results of a Randomized Controlled Trial Comparing Patients Rehabilitated with Immediately Loaded Maxillary Cross-Arch Fixed Dental Prosthesis Supported by Four or Six Implants Placed Using Guided Surgery. Clin Implant Dent Relat Res. 2016 Oct;18(5):965-972. » Since 2016 dental technician in joint practice Dr. Bayer & Colleagues » Specialist in the field of CAD/CAM, ceramics and implant restorations » Attends continuing education courses and professional lectures on dental technology topics and dental photography Dr. Bayer & Colleagues Von-Kühlmann-Straße 1 86899 Landsberg am Lech info@implantate-landsberg.de implantate-landsberg.de Sandra Kirchmaier References » Study of dentistry at the Ludwig Maximilian University of Munich » Since 2018 in joint practice Dr. Bayer & Colleagues » Focus on implant dentistry, esthetic dentistry and endodontology Dr. Bayer & Colleagues Von-Kühlmann-Straße 1 86899 Landsberg am Lech info@implantate-landsberg.de implantate-landsberg.de Dr. Maximilian Wienke 24. After many years of suppressing her smile, it still looks a bit tense, but it is the first time she proudly shows her teeth again. Discussion / Summary CAD/CAM-fabricated, screw-retained bridge constructions according to the COMFOUR procedure can meanwhile be considered a clinically evaluated, evidence-based implant prosthetic restoration in the edentulous jaw [1, 4, 5, 6]. CAD/CAM fabrication guarantees a high accuracy of fit here, particularly in the area of the angled screw channels. This, in turn, significantly expands the range of indications for implant-supported rehabilitation, even in cases where augmentation surgery is not indicated or is rejected by the patient. Any necessary repairs and hygiene measures such as PTC can also be performed more easily and thoroughly with partially removable superstructures, which in turn reduces the risk of peri-implantitis. However, the success of an immediate complete implant prosthetic restoration in patients who have a desolate dental status in the upper and lower jaw as a result of marked dental anxiety is strongly influenced by other factors, such as sustained and committed compliance and regular recall to support continued oral health. This requires a participatory therapy decision in advance, based on the professional as well as communicative competence of the entire treatment team. Given a suitable bone structure, a COMFOUR restoration, even with only four implants per jaw, can restore positive self-esteem in such, not so motivated patient who will then have teeth that match his/her personality and with which he/she can “simply live normally again”..
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