CAMLOG Hybrid Restorations

10 HYBRID RESTORATIONS WITH THE CAMLOG ® IMPLANT SYSTEM INTRODUCTION Modern implant prosthetics is planned by working back from the desired therapy goal; this is referred to as "backward planning." It applies particu- larly to pre-implantation augmentation procedures to restore sufficient bony structure to allow placement of implants in the optimal prosthetic position. The restoration of function, phonetics and enabling good hygienic potential of the prosthesis in an edentulous arch require prosthetically oriented im- plant positioning and dimensioning, which the dental technician can define on the basis of the specific oral situation with a wax-up/set-up. The pros- thetic design and the required implant position(s), axial alignment(s) and implant-supported anchorage options are planned and selected by the den- tist and dental technician working closely together. This requires both to be fully informed of the treatment options. DIAGNOSTIC CASTS, WAX-UP/SET-UP Diagnostic casts are used to represent the oral anatomical features such as the contour and size of the alveolar ridge, vestibular folds, oral bands and retromolar areas. The diagnostic casts are mounted in an adjustable articu- lator with the aid of an arbitrary face bow and centric registration, making it possible to represent the planned prosthetic restoration in the form of a wax set-up. The planned prosthetic result, the planned implant positions and the contour of the alveolar ridge are taken into account. DIMENSION CONTROL WITH SILICONE INDEX A silicone index created from a wax set-up is used to represent the space requirement for the planned full denture restoration on the diagnostic cast. The index should embrace the tooth arch from oral to vestibular. After cur- ing, the index is divided along the incisal or occlusal midline. After remov- ing the set-up, the corresponding silicone index half (buccal or palatinal/ lingual half) shows the space requirement for the restoration. The silicone index can then be used to determine optimal implant positioning, axis align- ments and anchoring systems. ARCH RELATIONS The arch relations has effects on the load direction and therefore on the axial alignment of the implants. This is particularly important with cross-bite situations. X-RAY/DRILLING TEMPLATE WITH CT-TUBES FOR CT PLANNING In a planning template fabricated on the diagnostic cast, CT-tubes are inte- grated at the ideal implant position and are used as reference positions in the x-ray image. The CT-tubes have two parts, and the titanium material does not cause any scattering of rays in the CT/DVT. The lower section is polymerized into the template. The upper section is pluggable. The entire CT-tube is used for the radiological diagnostics; the upper section can be removed for surgery. Depending on the software used for the evaluation, titanium CT-tubes or other radio-opaque positioning elements (e.g. steel, barium sulfate) are integrated for the CT/DVT-supported planning. Placing the CT-tubes directly on the mucosa makes it possible to determine density in the CT/DVT. The documentation included with these systems contains more information on this topic. As an alternative to the drilling template with CT-tubes for CT planning, a drilling template can be fabricated with the CAMLOG ® Guide System that is used for template-guided preparation of the implant bed and for inser- tion of SCREW-LINE implants CAMLOG ® Guide. Further information is available in the "CAMLOG ® Guide System" working instructions, Art. No. J8000.0107. PLANNING OF THE PROSTHETIC RESTORATION Ø 2.5 mm external diameter 10 mm 4 mm CT-tubes for CT planning for pilot drill Ø 2.0 mm Drill for placement of CT-tubes, Ø 2.0 mm Ø 2.1 mm internal diameter