Implant Dentistry Today No 14

Implant Dentistry Today 33 Professional opinion of the product and the procedure “In this case, it was possible to extract all teeth and place the implants after small bone reduction during the same surgery, making it more convenient for the patient since he had only one single surgery. The coronal bone cortex was consequently removed after bone reduction/flattening, so implant anchorage relied on the apical cortical layer. The use of Helix GM® Long implants in a case like this increases the chances of success of the immediate loading procedure, since it enhances the chances of higher primarily stability, that should be minimum 32 N.cm .” What were the other treatment options? “Due to the presence of infection on the remaining teeth, some doctors would prefer a conservative treatment plan and to extract the teeth before placing the implants. Nowadays, it is well known that doing previous antibiotic therapy before the surgery and the intervention in one single surgery does not change the risks of failures. What is really important is to have the infection in the chronicle stage and not acute inflammation. The use of hydrophilic surfaces in challenging situations is also something to be considered in a situation such as this.” Were there any challenges during the treatment? “On the top of the challenges previously discussed in the answers above for this case, it also was defined for the treatment plan a minimum number of implants. With minimum number of implants, the future hygiene may be improved as well as the fabrication of the prosthesis. For this, implant distribution may be considered a key for success. Basically, for the lower arch the posterior implants were placed in the area of 1st or 2nd premolar, in order to minimize the cantilever. In the same way, the anterior implants were placed on the area of the inferior incisors, in order to result in a larger resistant area for the bridge.” TIPS “In order to seek a more accurate final restoration (a hybrid bridge, with acrylic teeth and metal framework), a multifunctional guide was previously made before the surgery. So, right after the surgery was finished (suturing), open tray copings were screwed over the mini conical abutments and splinted with acrylic resin between them and to the multifunctional guide. The multifunctional guide is basically a replica of the teeth in wax previously made before the surgery, with transparent acrylic resin. This device allows the surgeon to have: a tomography/ radiographic guide before the surgery, a surgical guide during the surgery, a customized impression tray and a device for bite registration after the implants were placed in the proper positioning. It allows lab technicians to have the proper information they need to produce a hybrid bridge as faster as possible. Another important aspect of the multifunctional guide is regarding the final “rotational” position of the posterior implants. Since tilted implants results in only six position for the angled abutments, the surgeon needs to adapt a positioner pin to the implant in order to check the implant final positioning before placing the final mini conical abutment. Once the emergence of the implant to the multifunctional guide is correct, the final abutment can be adapted. “Curvy” angled abutments may allow a reliable procedure, since it increases the changes of not using the bone profile drill.” n Figure 5.1 and 5.2 – Neodent® Helix GM® Long Implants 4.0 x 22.5 mm placement on distal regions. Figure 6 – Installation of four implants Figure 7 –Try-in of the wax teeth for protocol preparation Figure 10 – Clinical aspect of the prosthesis protocol 4 months after surgery Figures 12.1, 12.2 and 12.3 – Periapical radiographs 4 months after rehabilitation Figure 11 – Clinical aspect of the Mini Conical Abutment 4 months after surgery Figure 8 – Prosthesis protocol installation under immediate load Figure 9 – Panoramic radiograph 7 days after surgery