Clinical application examples - planning and surgery with PROGRESSIVE-LINE Guide Intraoperatively, the implants demonstrated very good primary stability, and the postoperative control image revealed correct implant positions (sinus lift at 16, 26). One can clearly observe the external geometry with its progressive, projecting thread design as well as the already inserted COMFOUR® Abutments. The titanium caps screw-retained onto the bar abutments were polymerized. The high titanium caps allow secure, dry intraoperative bonding. Precise planning and surgical implementation were reflected by the fact that the bonded areas did not require reworking. After finishing and polishing, the temporary restoration was incorporated on the day of surgery. At removal of the sutures after one week, the gingival conditions were free of irritation with the onset of papillae and pontic formation. The punctures of the fixation pins are still visible apically 13, 23. After osseointegration of the implants, the definitive prosthetic restoration is to follow four months later. For minimally invasive implant surgery, the jawbone was first exposed using a gingiva punch. Preparation of the implant sites followed in accordance with the surgical protocol. An external sinus lift was performed in region 16 and an internal sinus lift in region 26 with the implant (Geistlich Bio-Oss® bone substitute material). The PROGRESSIVE-LINE implants with screw-retained insertion posts were inserted to the exact stop on the sleeves. Alignment of the inner configuration is realized via the markings. Positioning of the CAMLOG® groove is important to ensure the planned common insertion direction when using angled abutments. In this case, straight COMFOUR® Abutments were screwretained in the primary stable anchored implants following implant insertion. This was followed by extraction of the nonsustainable teeth and suture closure of the extraction sockets in the area of the external sinus lift 16. Baseline clinical findings on the day of initial presentation. The periodontally damaged teeth 15, 25 and 27 are clinically mobile and not worth preserving. To be able to offer the patient an optimal and safe solution, guided implant insertion was preferred. To stabilize the planned SMOP template, the teeth were left in place until implant insertion. To define the surgically and prosthetically optimal implant positions, the osseous situation in the form of DICOM data, the STL data of the clinical situation and the virtual tooth set-up served as the basis. Implants under still existing incorporated metal constructions can be planned reliably with imaging techniques. After checking the esthetics and function of the printed wax-up, the position and axial direction of the implants were defined by virtual articulation of the scanned models and by matching with the X-ray data on the one hand. On the other, the accompanying necessary surgical measures were pre-planned. Immediate restoration in an edentulous maxilla Dr. Jan Spieckermann, Chemnitz For minimally invasive guided implant placement, the drilling template was constructed in a "spaghetti design". The natural teeth in region 15, 25 and 27 and two anchor pins in the anterior tooth region were used for the exact positioning of the template. These additionally secure the template against tilting. The pontic in region 26 was removed prior to surgery. Simultaneously with the 3D printing of the template for guided surgery, a milling order for the long-term temporary restoration was placed with a milling center. For intraoral bonding of the immediate temporary restoration, the areas to accommodate the titanium caps were recessed. The template, which was anchored tilt-resistant via pins, enabled the precise transfer of the implant position to the clinical situation. The guide sleeves of the template were used for implant bed preparation and insertion of the implants. Here, the focus should be placed on the insertion depth and alignment of the inner geometry of the implant.
RkJQdWJsaXNoZXIy MTE0MzMw