CAMLOG Special Issue – Implant Navigation

Case Report 06 | 2010 Fig. 9: The occlusal stops for fixing the position of the DVT template. Another factor to prevent movements during recording. The 68-year-old female patient presented with a wish for improved retention of her removable dental prosthesis after extraction of teeth 34 and 35, that could not be preserved. The goal was a template-guided and template-navigated implant insertion created with a three- dimensional data set and planned from a prosthetic standpoint in order to enable an implant-borne telescopic restoration, that would be as minimally invasive as possible for the patient despite severe bone atrophy. Three- dimensional volume tomography (3D-VT) was prepared with the aid of a scan template. The intraoperative navigation template could then be fabricated in a lab with the aid of this virtual 3D plan. The basic aim here was an optimal implementation of the planning coordinates from the information provided by the planning scan template up to the desired INFORMATION ON PATIENT AND TREATMENT Fig. 6: The lab versions of the temporary implants (Mini Sky, Bredent) on the model. They are used to fix the bite plate, set-up and DVT template. With these tools, positional stability and secure retention of various templates can always be guaranteed in an edentulous jaw. Fig. 7: The mandibular set-up on the model. It is used for in- itial orientation of the occlusal position as well as es- thetics. Fig. 8: The DVT template (Med 3D) fabricated with the set-up and with three reference points (gutta- percha pins bilaterally in Region 3 and a Lego brick) to prevent any transfer errors. Fabrication of the scan template after a wax-up with a prosthetic focus implant position, which was adapted from the X-ray template into the drilling template with the aid of a special drilling bench. After a vertical crest reduction had been carried out, four CAMLOG ® SCREW-LINE implants were inserted via template-guided navigation and laterally augmented on both sides. In the present case, transversal divergence led to a decision to firstly load the inserted implants temporarily for two months via the gingiva formers as part of progressive bone loading and only then insert the prosthetic appliance. Because securely fitting an implant drilling template supported only on the mucous membrane is problematic in an edentulous jaw, temporary implants were inserted as reference pins before the main implant insertion. Fig. 1: Pre-operative condition with extremely loose teeth and insufficient prosthesis retention. Tooth 43 previously had to be surgically removed due to a transverse fracture. Fig. 2: With the prosthesis anchored on one side, the remaining teeth had been severely loosened. Pre-operative condition with remaining teeth not worth preserving Fig. 4: Immediately after that, the temporary implants were inserted as reference pins. Fig. 5: Postoperative OPG after tooth extraction and inser- tion of temporary implants. Fig. 3: The extremely loose teeth 33 and 34 were extracted without any trauma. Temporary implants for secure referencing of the navigation template