CAMLOG Special Issue GUIDE SYSTEM

Case Report 09 | 2011 Fig. 8: The system-specific matrices are placed and secured in the scan template with plastic. The planned minimally invasive flapless proce- dure for implant insertion requires a unique fixa- tion for the preparation of radiological materials. The fixation is facilitated by temporary implants in a suitable position. In order to ensure accurate transferability, the fixa- tionmust beperformedunder radiological control in the identical position as the one of the implantation. The male patient aged 59 was looking for a new fixed restoration for his maxilla. His case history showed no general disease. The patient had been fitted with telescopic model casting prostheses in the maxilla and mandible. Due to the periodontally insufficient anterior residual teeth in the maxilla (teeth 12, 11, 21, 22), the prosthesis could no longer be supported. After loosing the residual teeth, the patient wanted a fixed implant-based resto- ration of the maxilla. The residual teeth of the mandible showed the following findings: tooth 48 was impacted and displaced, tooth 45 showed mobility grade 3 and was periodontally insufficient. The anterior residual teeth 33–43 presented with in- creased probing depths on the canine teeth and increased mobility (grade 2). Information on patient and treatment Fig. 7: Two-part temporary implants fitted with ball abut- ments in positions 11 and 21. Posterior anchorages in positions 15 and 25. Implant placement The treatment strategy for the maxilla included as a first step a conserva- tive periodontal therapy of the anterior residual teeth for strategic preser- vation and fixation of the existing prosthesis until implant insertion. After- wards, the residual teeth were removed and a bilateral sinus floor augmentation was performed in a two-stage procedure. Following a 3-D planning, eight endosseous implants were inserted with the CAMLOG ® Guide System in a flapless procedure, and the prosthetic restoration was re- alized using a telescopic bridge. In the mandible, tooth 45 was removed while the other teeth were treated with conservative periodontal therapy. The mandibular posterior teeth were replaced and realigned. Teeth 43–33 received reveneering of the re- movable denture. Fig. 1: Panoramic radiograph. The maxillary posterior re- gions on both sides show significantly reduced verti- cal bone height (residual height less than 2 mm). Fig. 2: Clinical situation with removable telescopic pros- thesis inserted. Initial presentation Sinus floor augmentation Fig. 4: F illing of the right sinus cavity with blood and xeno- genic bone substitute material. Coverage of the lateral windowwitha resorbable collagenmembrane toavoid displacement of the bone substitute material. Fig. 5: P ostoperative panoramic radiograph shows filling of both maxillary sinus cavities. Fig. 6: Panoramic radiograph with scan prosthesis for de- termining the fixation positions using the four in- terim implants. Fig. 3: T he facial maxillary sinus wall is moved inwards and becomes the neurocranial floor of the maxillary si- nus. On the left side, a vertical bone septum (visible on Fig. 1) requires two separate lateral approaches. Insertion of interim implants