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logo 39 • the CAMLOG Partner Magazine • November 2016 14 CASE STUDY After a healing period of three months and successful augmentation, a CAMLOG ® SCREW-LINE Promote ® Implant with a length of 13 mm and a 3.8 mm diameter was inserted. As the patient was a heavy smoker, submerged healing was chosen. Exposure of the implant was performed after a further three months (Figs. 14 to 16) . A connective tissue graft was inserted to improve the contours, however the patient's heavy consumption of nicotine led to a partial loss of the connective tissue graft. Accordingly, healing could not be regarded as being ideal, particularly with regard to the mesial surface of tooth 12 (Fig. 17) . As the patient was unable to a guarantee a 10-day smoke-free period, we decided against a new intervention and for gingiva forming with a long-term temporary restoration. Prosthetic phase I The objective of the first prosthetic phase was finding the ideal jaw relation for the patient as well as setting the physiological bite level using semi-permanent repositioning onlays. The implant in regio 11 was restored with an occlusally screw-retained long-term temporary restoration. Over the course of functional therapy, this allowed the shaping of soft tissue through successive application of flow composite (Fig. 18) . The initial protective splint was now replaced with a deprogrammer according to J. Kois. The patient was advised to wear this splint as often as possible. After a wear period of six weeks and concomitant physiotherapeutic treatment, the jaw relation was determined with the aid of the Kois splint [3]. This acted as basis for a diagnostic wax-up for the dental technician (Fig. 19) . A detailed treatment plan was prepared following successful analysis of the model. The diagnostic set-up not only provided information on the desired bite elevation and occlusal design, but also on esthetic aspects. With a corresponding mock-up on the patient, one could demonstrate how the esthetic parameters such as tooth length, facial profile and physiognomy would change. Successful initial functional therapy with improvement of patient- specific complaints is regarded as a conditio sine qua non for subsequent restorative therapy [4]. In this case there was considerable relief of headaches. We therefore decided to elevate the vertical dimension and stabilize the ideal jaw position for the patient via semi-permanent reposition inlays. A two- stage procedure, as described by the Hamburg working group of PD Ahlers, was chosen [4]. The envisaged bite elevation of 4 mm in total was implemented in both jaws. In the region of the anterior teeth, the size ratios were implemented according to the rules of the "golden ratio". This also simplified the esthetic design of the implant crown in regio 11. The lab-fabricated PMMA reposition inlays were bonded successively to the opposing quadrants in the maxilla and mandible. Extension of the anterior teeth and the temporary implant crown in regio 11 was performed chairside using silicone matrices and flow composite (Figs. 20 to 24) . In order to protect the restoration and for better adaptation of the neuro-muscular Fig. 14: Implantation was performed three months after regeneration of the graft. After a further three months, the gingiva was shown to be attached with sufficient thickness. Fig. 15: Shaping of the buccal contours can be seen clearly from occlusal. Fig. 13: The temporary restoration was performed in a classical manner with a flipper without pontic support. Fig. 20: Situation after insertion of the reposition onlays in the maxilla... Fig. 19: Diagnostic wax-up of the maxilla and mandible according to functional and esthetic aspects.