implants - international magazine of oral implantology

I clinical technique _ troubleshooting Fig.11_Customisedabutmenttooth asaterminalabutment. Fig.12_Patient’soralcondition. Figs.13&14_Wewereabletopre- servethebridgeintheleftmaxilla. Fig.15_Threeimplantshadoriginally beeninsertedtotreatanodontiainthe secondquadrant. Figs.16&17_Thedistalimplantwas lost;thedetailedviewshowsthenon- functionalcrown#25. Fig.18_Conditionafterre-implanta- tiondistallyoftheimplantlocalization. Implantfracture Fig.19_Thedistal(diameter-reduced) implantofabridgesupportedentirely byfracturedimplants. Fig.20_Anadditionalimplantwas inserteddistallyafterremovalofthe fragmentthathadremainedinthe bone.Afterintegrationoftheimplant,a newbridgesupportedentirelyby implantswascreated,whileincorpo- ratingtheformerimplant. willbecoveredandevaluatedin this article. The purpose of this is to demonstrate solutions so that the patients affected re- ceive a modified solution in or- der to preserve the existing and very expensive work. _Loss of implant due to peri-implantitis (Figs. 9–18) A bridge structure in the second quadrant had been in place without any problems in a 50-year- old female patient for 10 years. Therefore, she only came to recall and follow-up examinations sporadically. The problem-free period ended abruptly when swelling and bite pain occurred in thelefthalfofthemaxilla.Apanoramictomogra- phy revealed radiological indications of a pro- found osseous defect around the mesial implant, which had to be removed on the same day. The is- sue then was the entire supra-structure. The pa- tient insisted that this structure be preserved ow- ing to the financial cost of having a new structure created after re-implantation. Our solution A new implant was inserted after the soft tis- sueandbonehadhealedintheareawherethelost implant had previously been in place. The bridge structure that had been temporarily affixed on the remaining implant was used as guidance for incorporation of a replacement implant and then removed for the actual implant procedure. After osseointegration of the artificial abut- ment tooth, we inserted a plastic abutment and made a casting of the integrated bridge structure with polyether casting material. This customised abutment was transformed into metal and the bridge structure finally cemented in place after a trial insertion. _Implant fracture (Figs. 19 & 20) Diameter-reduced implants can often be im- planted even in a reduced osseous bed and aid in the avoidance of augmentations. However, when introduced into the market, diameter-reduced implants were frequently used for other indica- tions as well; some authors even recommended usingthemasstandardimplants.Stressphenom- ena caused a considerable number of implant fractures, resulting in markedly restricted indica- tions for diameter-reduced implants. The case presented here reflects the typical progress of this early phase. A purely implant- supported (two abutments) extension bridge was incorporated into the fourth quadrant. A diame- ter-reduced implant was used in spite of an oro- vestibular bone dimension that would have been sufficient for supporting a standard implant. The result was that the distal implant fractured after eight years. Our solution In one surgical session, we removed both the implant fragment remaining in the bone by way of an osteotomy and placed a further distal im- 28 I implants2_2011 Fig. 17Fig. 15 Fig. 16 Fig. 18 Fig. 20 Fig. 21Fig. 19