Partner Magazine logo 13

CASE STUDY 10 Full thickness mucoperiosteal flaps were then prepared. Using the surgical tem- plate, the surgeon prepared the implant bed corresponding to the lengths and diam-eters of the implants and inserted the CAMLOG ® SCREW-LINE implants in ac- cordance with the surgical protocol (Fig. 9) . To avoid a sinus lift, a short implant (length 9 mm, diameter 3.8 mm) was in- serted in regio 26 (Fig. 10) [6]. An insert- ion post was screwed in and the implant was covered with the cover screws. The flap was mobilized using a periosteal slit. In regio 23 the surgeon augmented the buccal bone lamella with a mixture of autologous bone chips and an alloplastic bone graft ma- terial (easy-graft™ CRYSTAL). Smaller bone defects in the surgical field were evened out using autologous bone chips harvest- ed from the threads of the drill (Fig. 11) . To encourage wound healing, the entire im- plantation area in the upper jaw was cov- ered with PRF membranes (Fig. 12) . Over a period of seven days, the membrane re- leases the integrated growth factors and accelerates and improves wound healing [7]. The matrix obtained by concentrating the patient’s own platelets is a cost-effec- tive preparation and is easily processed thanks to the inherent consistency. The soft tissue was then sutured without ten- sion using mattress and simple interrupted sutures (Fig. 13) . The temporary prosthesis was well supported over the gingiva, the terminal tooth 27, and the stable ridge around the incisive papilla. After eight days we were able to remove the sutures. Once the soft tissue had healed, we relined the temporary prosthesis with plastic a few days later. Exposure and contouring a natural emergence profile The patient attended our clinic at the start of June 2014 for prosthetic restoration. We exposed the implants with simple stab incisions and apically positioned flaps. In regio 22 we expanded the gingiva with a roll flap so that a natu- ral and attached soft tissue situation could be preserved around the implant and the crown (Fig. 14) . Because we wanted to individually con- tour the soft tissue, we screwed on the platform switching impression posts for the closed tray technique and sutured the soft tissue (Fig. 15) . To provide better sup- port for the model, we placed the bite reg- ister over the impression posts. We then took an impression of the situation using an individually prepared tray. After the impressing taking, the impression posts were replaced by straight healing caps that remained in the mouth until the pa- tient attended the appointment to insert a screw-retained temporary plastic bridge. The temporary prosthesis was milled by us around the implants. In the laboratory the impression posts were screwed onto the lab analogs, inserted into the impression, and injected around with silicone for the removable gingival mask. After the mask had cured, the upper jaw master model was fabricated. In our clinic the focus is always on the natural appearance of a restoration. This includes not only the anatomical design of the crown emergence profile but also the basal contouring of the pontics [8]. To achieve this, the dental technician places the esthetic set-up on the model and draws the cervical contours of the crowns and pontics onto the master model [9]. The gingival mask in the areas of the pon- Fig. 7: Using a crestal incision and subsequent flap preparation, the jaw bone was exposed. Fig. 8: Leaving a central ridge provides support for the temporary prosthesis and simplifies the precise repositioning of the soft tissue. Fig. 9: Backward planning is a prerequisite for prosthetically correct positioning of the implants. Fig. 13: The wound margins were precisely ad- apted and the soft tissue was tightly closed up using simple interrupted sutures and mattress sutures. Fig. 14: The implants were exposed with a simple stab incision and the mucosa in regio 22 was widened with a roll flap. Fig. 15: To produce a CAD/CAM-fabricated screw-retained plastic bridge, immediately after exposure the abutments were attached to take an indirect impression.