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8 A TOTAL CONCEPT FOR TREATING AN UPPER JAWWITH INDICATION CLASS IIIa Dr. Albert Holler, Arzberg, Dr. Marc-André Grundl, MDT Kurt Illing, both Marktredwitz The indications and the success rates for implant-supported restorations are far greater today than at the start of implant development (1960 to 1980). Nowadays implant-supported restorations are a scientifically established and essential part of modern oral treatment concepts. According to the scientific gold standard, in cases of complete edentulism in the upper jaw eight implants are usually sufficient for a high-quality fixed reconstruction [1]. Our patients often want fixed and esthetic restorations instead of removable restorations or complete dentures. Rehabilitation of an edentulous upper jaw with a cemented zirconium bridge on eight DEDICAM titanium abutments after 3D planning and template-guided implant insertion is described below. In complex clinical situations, good com- munication between the treatment team, the dental technician, and the patient is essential for the long-term stability of a rehabilitation. A thorough preliminary examination and carefully determining the indication help to avoid any fail- ures. It is important here that before the treatment starts all members of the team are focused on achieving the best possi- ble functional design of the prosthesis, respecting the wishes of the patient in terms of esthetics, and promptly iden- tifying any complications or clinical or technical limitations. Using CAD/CAM technology enables precisely fabricat- ed restorations to be constructed from biocompatible materials such as high- performance polymers, titanium, or zirconium oxide. Fabricating these restora- tions using an analog process is often not possible or requires excessive effort. The precision of a CAM-prepared restoration is no longer an issue. Findings and planning of the com- plete concept In March 2013 a complete surgical and prosthetic concept was prepared for the 56-year-old patient. The bridge in the patient’s upper jaw was broken in several places. Radiographs revealed that the ab- utment teeth were periodontally compro- mised and could not be retained apart from the terminal molar in the second quad- rant. The bridge from 35 to 37 required rejuvenation and the edentulous space in the fourth quadrant needed to be closed up (Fig. 1 to 4) . So that a comprehensive plan could be prepared, panoramic radio- graphic images of the current oral situation were prepared for analysis. An impression was taken of both jaws to create models of the situation. So that the models could be articulated relative to the skull, a facebow was inserted. The periodontal screening was normal. A functional analysis did not reveal any signs of craniomandibular dys- function. Because the patient did not want a full prosthesis, we presented her with two prosthetic restoration options. One was a removable telescopic bridge that would be realized with five implants and a telescop- ic crown on tooth 27 in the upper jaw, or alternatively a fixed cemented bridge restoration supported on eight implants. To restore optimal chewing function, two bridges on natural teeth in the lateral lower jaw were suggested. After explain- ing the differences between the various Fig. 1: The radiograph illustrates the current oral situation. Fig. 2: The upper jaw bridge had jutting crown margins. Fig. 3: The bridge was broken in several places and the ceramic veneers were sheared off. CASE STUDY