COMFOUR Special Issue

6 7 After the titanium caps for bar abutments were shortened according to the occlusion, we screwed them on and scanned in the model. The digital model data were matched with the data from the setup, the construction was completed digitally, and the temporary restoration was fabricated in the CAM procedure using a high-performance polymer (Fig. 12 to 16) . The polymer bridge was separated from the blank and the fit checked, ensuring that there is sufficient space around the titanium caps for the intraoral “adhesion” (Fig. 17 to 19) . The surgical phase The surgery was carried out under intubation anesthesia on April 23, 2015. Firstly, we carefully removed the lateral incisor 22 because this region was intended for the strategically correct posi- tioning of an implant based on the Maló princip- le (Fig. 20) . The remaining teeth were used for precise and stable fixation of the template during the fully guided insertion of the four CAMLOG ® Guide SCREW-LINE Implants (Fig. 21) . The four implants (region 12 Ø 4.3 mm CAMLOG ® SCREW- LINE Implant 13 mm length, region 22 Ø 4.3 mm/ L 13 mm, region 14 Ø 3.8 mm/L 9 mm and region 25 Ø 3.8 mm/L 13 mm) [6] were inserted using a minimally invasive procedure according to the Guide protocol and the inner configuration was aligned with the marking on the Guide sleeves. The Guide insertion posts were then screwed on, the template removed, and the anterior teeth ex- tracted (Fig. 22 to 26) . The implants were then rinsed, and the 17° angled bar abutments were inserted in regions 12 and 22. These were supplied pre- mounted on a flexible insertion handle in sterile packaging. With the help of this handle, the abutment is positioned with the precise angular alignment into the implant (Fig. 27) . To insert the abutment screw, the handle is bent to one side, giving the surgeon free access to tighten the screw using the new, slim socket screwdriver (Fig. 28) . In the same way, the 30° angled bar abutments could also be rapidly inserted with pre- cise alignment and then screwed in (Fig. 29 and 30) . We then screwed the titanium caps without rotation protection onto the COMFOUR TM bar abutments and checked that sufficient space had been created around the caps to polymerize into the temporary restoration (Fig. 31 to 33) . Fig. 12: Two 17° angled COMFOUR™ bar abutments were used in the anterior region and two 30° angled bar abutments were used in the dorsal area. Fig. 14: The titanium caps were shortened according to the occlusion and screwed on. Fig. 15: The model with the titanium caps screwed on was scanned … Fig. 18: To ensure the hygiene of the restoration, the basal rest areas and the interdental areas were polished. Fig. 19: Checking the fit on the model indicated that the immediate restoration can be bonded in the mouth without tension. Fig. 22: In compliance with the minimally invasive Guide protocol, the implant bed in region 22 was prepared. Fig. 23: The CAMLOG ® SCREW-LINE implant Ø 4.3 mm/ L 13 mm was inserted through the sleeve to the depth stop. Fig. 21: The Guide template was stably fixed over the remaining teeth. Fig. 16: … and matched with the previously scanned setup. Fig. 17: The immediate temporary restoration was milled from high-performance PMMA and the areas around the titanium caps were generously ground away. Fig. 20: Tooth 22 was first carefully extracted. Fig. 25: After preparing the implant bed, three implants were inserted fully guided. Fig. 29: The figure shows the approximately parallel alignment of the screw channels of the prosthetic restoration by means of the angled bar abutments. Fig. 30: The flap was formed after a crestal incision with a central band preserved around the incisive papilla. Fig. 28: The abutment screw was tightened using the socket screwdriver. To gain access, the flexible handle was gently bent to one side. Fig. 26: The periodontally compromised, non-preservable anterior teeth were extracted after removal of the template. Fig. 27: The 17° angled bar abutment was inserted into the implant with the help of the insertion handle with precise alignment. Fig. 24: The figure shows the precise alignment of the insertion post in relation to the inner configuration of the implant. Fig. 13: COMFOUR™ bar abutments angled at 17° and 30° and with various gingival heights. They are also available as type B. Not shown: Straight bar abutment. CASE STUDY CASE STUDY