-- - --Vol.9 .Issue 2/2008iSi~8'16~SA5.

of orai impanto!ogy, 22o08

~

-,-userreportEarlyloadingof rootform - --: >

andconical implantswith a sand- . J~

blasted large-grit acid..etchedsurface: A 6-year clinical follow-up

_social events4thArab-GermanImplantology Meeting in DuQaia Great Success

- worldwide eventsDGZIand Aa Boardsof Directors Met in Boston

~ ;?".G Z iZohnöndlche 711SChoft türimpontologie o.V.

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"

-.... i content_implants

i editorial

03 Quality and Professionalism"made in Germany"

- RolfVollmer

i report

- user report06 Bone-oriented implantation with

wide implant diameters- Hans-Oieter John, Germany

- case report1O An alternative prosthetic solution arter

lass of three out of six maxillary implants- Hakan Bilhan, Semra Can, Turkey

- user report14 Early loading of root form and

canical implants with a sandblastedlarge-grit acid-etched surfare:A 6-year clinical follow-up- Wiebke Semper, Susanne Heberer, Katja Nelson,

Germany

- user report20 Deployment of a 4 iOnm Diode Laser

Prototype-first experiences with the"biiie diode"- Georg Bach, Germany

i scientific article

- scientific article

28 Er:YAG Laser and desensitizingeffects on denIine and nede oftooth- Olaf Aberhofer, Germany

04 i Ii11plar:ts

~serreP<it 20 ii events

- social e\Jents

30 4t1iArab-Gerinan Implantology Meetingin Dubai a Great Success

- dubai abstracts

35 4t1iArab-Gerinan Implantology MeetingofDGZI-Selection of Abstracts

- worlclwicle e\Jents

38 DGZIandAOBoardsofDirectorsMet in Boston- The annual ranference ofthe AO-Academy of Osseointegration-wasa great success

- wol'ldvvide e\Jents

40 211dInternational King Abdulaziz University& 19t1iSaudi Dental Society Conferencefor Dental Technologyand Reseai"ch in March2008-Cooperation Agreement betweenDGZI and Saudi Dental Society

- implantevents42 Selected Events 2008/2009

i news

- social news

43 CongratulationsandHappyBirthdayto allDGZI-members around the world

- manufactui'er news44 Manufacturer News

Iabout publisher

50 Imprint

"'... l-casa - report

An alternatiye prostheticsolution after loss ofthree out of six maxillaryimplantsauthors- Hakan Bilhan 1, Semra Can2, Turkey

1 Dr med. dent., Istanbul University, Faculty of Dentistry, Department of Removable Prosthodontics2 med.dent., Istanbul University, Faculty of Dentistry, Department of Removable Prosthodontics

Fig. C The extraction of all

maxillary and mandibularteeth,

except #43 and #44.

Fig. 2- Panoramic x-ray of 6 upper

jaw and 610wer jaw implants.

Fig. 3- The maxilla after loss of

3 implants.Fig. 4- Frontviewof the fixed

detachablebridgebetween13-24.

Fig.5- Palatalviewof the fjxed

detachablebridgebetween13-24.

1 O i imp laB!~

_Abstract

Implant is generally a suc-cessful treatment modalitv.However, implant losses cancausedifficultiesconcemingtheprosthetic treatment. While asingle implant loss does notchangethe treatmentcoursebyitself, more than one loss canmake, for instance a fixed

restoration,which was promisedto thepatientinthebeginning,im-possible.This artiele describesacasewherethreeof the maxillaryimplantswerelost andadifferentprostheticsolution for the situa-tion wasapplied.Sincethe60yearoldfemalepatientwasinsistingona fixeddenture,at leastin thean-terior, a detachableanteriorpartwhichwasconnectedwith BEGO's

Ancora@precisionattachmentstothe cast frameworkdenturewasconstructed.The16-monthresult

wasencouraging,but to beabletodrawconclusionsaboutthe relia-

bility of this methoda longerob-servation period with possiblymorecasesisnecessary.

_Introduction

Implant isgenerallyasuccess-ful treatment modalitv.However,implant losses can cause realdilemmasfromtimeto time.While

a single implant loss does notchangethetreatmentcoursebyit-self,morethanonelosscanmake,for instancea fixed restoration,whichwaspromisedin the begin-ning,impossible.

"'-

- Case

After planning for a 60-year old female patient,following the extraction of all maxillary andmandibularteeth,excert #43 and#44 (Fig.1),lowerandupperimmediatedentureshavebeendelivered.Following a 3-month healing period, 6 implants(AstraTech@,Mölndal/Sweden)havebeenplacedinthe upperjaw.6weeksIater,6 implants (AstraTech@,Mölndal-Sweden)havebeenplacedin the lowerjawas well (Fig. 2). 3 months later (approximately5 months of osseointegrationtime for the maxillary implants)the patient was called for theimpression taking session forthe prosthetic restorations.Theimplant in the region #26 wasmoving,andsinceit wasnot os-seointegratedthe implant wasremoved.Hereupon,the treat-ment of the patient has beencompletedwith afixedprosthe-sis on 5 implants. IndividuallyprepableTi-design@abutmentswere selected for the maxilla,and Direct Abutments@ (As-traTech@,Mölndal/Sweden)forthe mandibula. Initially, thebridges have been cementedtemporarily and following a1 month period without com-plaints, they have been ce-mented with polycarboxylatecement (Adhesor@Carbofine-SpofaDental-a KerrCompany/CzechRepublic).Approximately3monthsIater,whenthe patientcamebackwith decementation

problemof the maxillaryrestor-ation, it wasobservedthat twomore implants in the upperjawwere mobile. After these im-

plantswereextracted,the situ-ation (Fig.3) was explainedtothe patient and the treatmentalternativeswere revised.The patient was initiallypromisedto have fixed restorations, furthermorerejectedanewoperationanddid not want to acceptany other alternative except the fixed restoratian.The patient strictly wanted the visible part of theprosthesisto befixed.Sotheoverdenturewith abar,which was our suggestion,was rejected.Sincethepatient insistedon herdemandsandwantedto takethe wholeresponsibility,afixeddetachablepart be-tween 13-24 (Fig.4,5) andacastmetalharnewürkdentureforthe posteridr(Fig.6)wasplanned.Anoc-clusalscrewedstructure for the anterior part wasplanned in order to prevent often decementation

due to dislodging forces duringdenture remova!.However,con-sidering the axial inclination ofthe remaining upper jaw im-plants (Fig. 7) making the oc-clusalscrewholesvisibleon the

front-teeth vestibular surfaces,it was determined to manufac-

ture a separate structure thatholdsthe precisionattachmentsand is carried on Uni Abut-

ments@(AstraTech@,Mölndal/Sweden) with occlusal screws(Fig.8,9).Asecondarystructurewould coverthe primaryone in-cluding the holes, thus solvingthe esthetic problem(Fig.10).

Considering that shrinkagewould occur during castingasaresult of the big volume of theprimary structure which wouldtransmit stress to the 3 im-

plants; a passive-fitting body,preparedwith a CAD/CAMsys-tem was preferredand ZiO2waschosen (ZIRKONZAHN-Denta-rius, Dental Innovation, ParmalItaly).

After taking the impressionsand having performed a vertical dimension deter-mination, atooth setupandtry in wascarriedout inthe next session,so both the agreementof the pa-tient in terms of aestheticsand data that would be

of valueto the laboratory werecollected.Then,theanalogue of the tooth set up was preparedwith apattern resin (Palavit G@-HeraeusKulzer GmbH,Hanau/Germany)and the teeth of pattern resinwere prepared(Fig.lla, b,c) and the precisionat-tachments (Ancora@, BEGO, Bremen/Germany)wereattachedto the most distal partsof the infra-structure. Later the ZiO2infrastructure was pre-paredcopying the pattern resinmodeland the su-

.

case- reporti

Fig.6- Castmetalframework

denturefor the posteriorpart.

Fig.7- Theaxial inclinationof the

remainingupperjaw implants.

Fig.8_A separatestructurewhich is

carriedon occlusalscrewretained

abutments.

Fig.9- Aseparatestructurethat

holdsthe precisionattachments.

Fig.10_Asecondarystructure

coveringthe primaryoneincluding

the holes,thussolvingthe esthetic

problem.

implap!,~ i 11

. ~case - report

Fig1Ja

Fig.11a- Thetoothsetup.

Fig.11b- The analogue ofthetooth

set up was prepared with a pattem

resin.

Fig.11c- Theteeth dtpattem resin

were prepared.

Fig.12- The patientalso likedthe

esthetics as well as the comtart.

Fig. 13_ln the radiographic exami-

nation 12 months later no important

bone lass was observed.

1 2 i implap~,~

perstructure was alsa finishedusing ZiO2.The east frameworkdenture with precisian attach-ments was fabricated in the

meantime, tae. With the porce-lain processing on the Zircansuperstructure, the restoratiantaek its fina ishape, and the pa-tient alsa liked the esthetics as

well as the comfort (Fig.12).UniAbutmen~ screws were tight-ened, whereas the bridge wastemporarily cemented (TempBond@-Kerr@). The patient wassatisfied with the end result.and no problem occurred inthe next 16 months. In the

radiographic examination 16monthslater noimportantbonelass was observed (Fig.13).

_Discussionand Conclusions

The lass rate in implants isgenerallv law,bui it has been re-ported that the number oflosses were concentrated insome patients.l Asimilar situation can be seen at theDepartment of Removable Dentures of the IstanbulUniversity,Facultyof Dentistry. 1610sses out of 19 of412 implants of a follow-up group have occurred inthe maxilla.15 implant losses outofthese16 were in 5female patients (three failures in each patiend. Com-mon about these patients apart from their gender isthat their dental history shows tooth lass due to peri-odontal problems.ln all5 patients type4 bone accord-ing to Lekholmand Zarb2was observed during the im-plani surgery.Can perhaps this kindof implant lass berelated to cytokine secretian rate and periodontiiishistory? Some display more inflammatory cytokineformation. therefore theyare more prone to periim-plani inflammation. Thepresence of IL-1 Betaand os-

1

teocalcin out of these cytokines could point out to thefact that a faster bone resorption should be expected.Ina study, it is reported that a weaker osseoadaptationshould be expected with the stimulation of Inter-leukin-l beta (IL-l beta, also called OAF-osteoclast

actiyating factor) and TNFalpha (tumar necrosis fac-tar alpha). OAFhas a significant physiological andhomeostatic role in the maintenance and repaif of

bone tissue, however it is not well

known to which extent it is physi-ologic and when it is pathologic.3The cyto-kinesgenerally triggerüsteacIasi formatian and activa-

tion.4 If the patient has a severechronic periodontiiis history,Sthepossibility that the causative fac-tors mav negatively influence thesuccessofimplants ishigh.6ln thiscase, Zirconium was preferred forthe manufacturing of the super-structure. It has been reported asthe result of several studies that

Zirconium shows a great strengtheven in long structures 7,8andthatthe fracture strength is compara-ble to metals9, 10,11,12,13,14 It is well

known that the shrinkage ofCAD/CAMmanufactured struc-tures, thus the possibilitythattheycause contraction on the abut-

ments is lower ihan after castingprocedures.1s,16It is alsa knownthat distal extensions can transfer

certain stresses to the implantsY,18,19However.if the distal exten-sion isthe width of a premolar,theforcesare expected to betolerable.Inthis article, a treatmentalterna-iiye that can be used for patientswith numerous implant losseshasbeen introduced. To be able todraw conclusions whether the

method is reliable or not a long observation periodwith more cases is necessary.-

For literature, please contact the author.

_contact implants

Drmeddent HakanBilhan

IstanbulUniversity,FacultyofDentistry,DepartmentofRemovableProsthodontics,34390 ÇapaIstanbul,TurkeyE-mail:bilhan@istanbul.edu.tr