IM0310

recommended, which is ensued by implant exposure and soft tissue conditioning (Fig. 2). The taking of im- pressionsoffourimplantswascarriedoutwithanin- dividually manufactured, bite registration-supported openimpressiontraymadeoflight-curingresin,given thatthepositionofeachimplantisfixedbythedrilling template.Theimpressiontrayisadditionallyequipped withbiteplatesthatcorrespondtothefixedbiteopen- inginverticaldimension(Figs.3and4).Theimpression takingwasdonebyusingalowviscosityA-silicontype material, which is advantageous due to the four im- pression posts (PITT-EASY, Sybron Implant Solutions, Germany) being connected without force or strain withself-hardeningresin(GC,PatternResin),through the use of the individually manufactured impression tray.Additionally,thisspecialimplantimpressiontak- ing technique enables a simultaneous fixation of the jaw relation, because the patient is brought into the right bite position at the time the impression materi- alsaresetusingbiteplates.Thisisfollowedbytheman- ufacturingofanimplantmastercastwithagummask andskull-relatedmountingofthemodels(Fig.5).Four titaniumabutments(threeV.D.L.abutmentsAnatomic Linestraight;one15°angulatedPITT-EASYabutment, Sybron Implant Solutions) (Fig. 6) were individualized accordingtothesofttissueprofile.Theywerealsoused to determine the height of the titanium abutments of the previously manufactured silicon matrix of the complete mandibular denture. Parallel primary crowns made of resin (GC, Pattern Resin) were mod- eled, milled, embedded, and cast on the abutments, observing the direction of insertion. These primary crowns have an occlusally open design. They are fixed on the titanium implant abutments, and after that, welded with a laser (Fig. 7). The laser-welding of the primary crowns and the titanium abutments requires very low power, as both alloys are extremely suitable for laser-welding. The individual implant primary crowns are milled in parallel (1°or 2°) according to the initialsituation.Boththeamountandtheheightofthe implantprimarycrownareimportantwithregardtothe alloyused.Thegalvanosecondarycrownsweremanu- facturedafterwards.Themanufacturingoftheimplant primary crown was carried out according to electro- plating requirements, i.e. the use of copper-free noble metal alloys (e.g. Stabilor NF IV, company Degu-Dent, Germany).Thegalvanocapsaredirectlygalvanizedonto theimplantprimarycrown(Solaris,Degu-Dent).Thisis followed by the manufacturing of the transfer guide and the rotation lock with buccal labeling. The resin transferguideisalsousedforcontrol,especiallybefore bondingthetertiaryconstructionandthegalvanosec- ondary crown in the oral cavity (Figs. 8-11). The finalis- ingoftheimplantcanbedoneafterbonding(AGCCem, Wieland, Germany) the galvano secondary crown with thetertiaryconstructionintheoralcavity.Aftertheden- tal prosthesis had been incorporated, the patient was still under individual preventive medical supervision. Therestorationdidnotshowanyradiologicalorclinical abnormalities(Figs.12and13). _Conclusion Theadvantageofindividuallymanufacturednoble metalprimarycrowns,whicharelaser-weldedtotita- niumabutments,isthattheydonotrequirecementfor fixation.Thisconstructioncaneasilyberemovedeven after its intraoral integration, and it thus guarantees the option for further extension of the prosthesis. Combiningthiswithatelescopicgalvano-superstruc- turealsooffersidealadhesionandavoidsfriction.An- other crucial advantage of this laboratory-based method is the cost-saving compared to industrially manufactured ready-made systems._ Fig. 7_Primary crown laser-welded to the titanium abutments, open in the occlusal direction. Fig. 8_Integration of laboratory manufactured primary crowns. Fig. 9_Control and transfer guide. Fig. 10_Galvano secondary crown. Fig. 11_Intraoral bonding of the sec- ondary and tertiary constructions. Fig. 12_Incorporation of the manu- factured prosthesis. Fig. 13_The road to success: from backward planning (above, left) to the finished prosthesis (below, right). I 27 case report _ prosthetic restoration I implants3_2010 Dr Christoph Thiemann Frankfurter Straße 69 59425 Unna,Germany Friedrich Schotsch Dental-Technik-Unna GmbH MPG geprüftes implanto- logisches Fachlabor Frankfurter Straße 67 59425 Unna,Germany _contact implants Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13