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CAD0111

I 35 industry report _ navigated implant placement I CAD/CAM 1_2011 when they need to be addressed. In particular, the prosthetic pre-surgical planning, which is of great importance, attains a completely new function as it can be compared, in a quality management approach, to the final result obtained after the treatment is completed in order to determine the degree to which the plan was actually imple- mented. Following radiological digitalisation of the patient by means of a double-scanning pro- cedure and conversion to virtual 3-D models, the surgeon can start to design the implants. In the present case, we planned to place six implants in the lower and eight in the upper jaw (Figs. 13a–n). The transitional dentures required after extrac- tion of the residual teeth also served as scanning templates (Fig. 14). Surgery In cases of a large number of implants to be placed, our team likes to implement a two-stage implant placement procedure. The lower jaw implants are inserted on the first and the upper jaw implants on the subsequent day. The patient was not subjected to general anaesthesia. It was possible to treat the phobic patient only with local anaesthesia without any problems. The sur- gical template used in combination with a specif- icallymatchedsurgicalkitallowedforexacttrans- fer of the 3-D computer planning to the patient’s mouth (Figs. 15 & 16). As in the first case, Nobel- Active implants were inserted, which afforded good primary stability even under the strongly re- duced bone conditions present in this case. This is owing to the special surface and the design of the implants. Following surgery, fixed temporary bridges, which had been fabricated ahead of time based on the existing planning, were inserted (Fig. 17). ProceraImplantBridge As before, the definitive form of management selected in this case was a NobelProcera CAD/CAM restoration.Thereweresomeparticularitiestotake into account in the management of both the lower andtheupperjaw.Thetruequalityoftheteamwork of dental office and laboratory becomes evident in the smooth production of very sophisticated rehabilitative restorations that can be fabricated without complication and incorporated into the stomatognathicsystemofthepatientwithoutany difficulties. As part of the production of the restorations for the lower jaw, the terminal molars (teeth #36 and 46) were fabricated as titanium single tooth crowns and screw-retained at implant level (Figs. 18 a & b). It was thus possible to take into account the 3-D twist of the arching lower jaw bone such that tensions at the level of the distal implants were prevented, which might otherwise have caused bone loss or even implant loss. We only splinted inter-foraminally in the lower jaw, between teeth #35 to 45 (Fig. 19). A distal can- tilevered pontic substituting for teeth #36 and 46 was not used in this case, as implants #45 and 35 wereonlyNobelActiveimplantswithadiameterof 3.5 mm. The Procera Implant Bridge Titanium on multi-unit abutments from teeth #35 to 45 was veneered completely, including gingival regions, using VITA titanium ceramic (Fig. 20). As before, Figs. 21 & 22_The framework was veneered with a gingiva-coloured ceramic material and opaquer was attached in the region of the stumps. Fig. 23_Model with Procera alumina single crowns. Fig. 24_Situation in situ with multi-unit abutments. Fig. 25_Procera Implant Bridge in situ before crown cementation. Fig. 26_Aesthetic appearance at the red–white transition. Fig. 26Fig. 25Fig. 24 Fig. 23Fig. 22Fig. 21