Herklotz, Insa

The purpose of this clinical study was to assess the feasibility of forced orthodontic extrusion with the Tissue Master Concept to retain subgingivally fractured teeth as abutments for which extraction and replacement would be equal treatment opportunities. Participants were recruited from a group of consecutive patients in need of prosthodontic rehabilitation. In total, 36 deeply destroyed teeth in 31 patients underwent forced orthodontic extrusion with forces exceeding 50 g to reestablish biologic width and ensure a 2-mm dentin-ferrule design prior to single-crown restoration. The primary endpoint was the success of the extrusion in terms of the ability to restore the respective abutment tooth. Information about overall treatment time, frequency, and reasons for failure were collected. Four patients dropped out of the treatment. For the remaining 27 participants, data were fully collected. The amount of extrusion ranged between 2 and 6 mm (3.5 ± 0.9 mm), and the mean duration until retention was 20 ± 12 days. On average, patients returned three (± 3) times for control visits after extrusion. Adhesive failure (n = 6) and orthodontic relapse (n = 2) were the most frequent complication types. Forced orthodontic extrusion may be a useful tool to restore teeth evaluated as nonrestorable.

Aim: To compare the planned implant position (PIP) with the transferred implant position (TIP) after fully guided implant placements in single-tooth gaps. Materials and methods: Dental implant placements were planned using two different implant systems (Camlog Screw-Line [C-SL] and Straumann Bone Level Tapered [S-BLT]), and two different planning software programs (SMOP and coDiagnostiX). All implants were placed according to fully guided protocols, and intraoral scans were performed intraoperatively. For the comparison of PIP and TIP, scan data were imported to Geomagic Control X (GCX) software and accuracies were evaluated. Deviations were reported in a coordinate system (x- [mesiodistal], y- [vestibulo-oral], and z- [vertical] axis) at entry points and apices. Total deviations, including angular deviations, were calculated with GCX. For statistical analysis, the level of significance was set to P < 0.05. Results: Twenty-six patients received 26 implants. Mean 3D deviation at the implant’s entry point was 0.61 mm ± 0.28 for C-SL and 0.63 mm ± 0.24 for S-BLT. For the implant’s apex, mean 3D deviation of 0.96 mm ± 0.41 was documented for C-SL and 1.04 mm ± 0.34 for S-BLT. Mean angular deviation was 2.58 degrees ± 1.40 for C-SL and 2.89 degrees ± 1.12 for S-BLT. Statistical analysis revealed no significant differences between implant systems, but showed significant deviations regarding the z-axis, both at entry point and apex (P < 0.05). Conclusions: Fully guided implant placements in single-tooth gaps provide accurate results. Due to significant vertical deviations, reevaluation of both drilling and insertion depths prior to implant installation should be considered. Maintenance of 1.5- to 2-mm safety distances to critical structures was confirmed. Keywords: dental implants, static navigation, CAD/CAM, computer-assisted, computer-assisted implant surgery, backward planning

Background: Treatment of the edentulous maxilla with a fixed full-arch prosthesis on four immediately loaded implants has been discussed as a treatment option, although generally five implants are recommended for that indication. The precise transfer of the virtually planned position by 3D-guided implant placement is an essential prerequisite for delivering the prefabricated temporary restoration at the time of surgery. Three-point support on the teeth or implants ensures that the template for the guided surgery is soundly seated during the operation. Case presentation: In the described case, the three-point support was carried out by teeth and temporary implants in the molar region inserted prior to the CBCT. The virtual implant planning determined the best prosthetic implant position while using the available bone to avoid extensive augmentation. Following this, a metal-reinforced provisional restoration was prepared using a drilling template. Four implants were placed in the planned position with the aid of a tooth-/implant-supported guide. The prosthetic axis of the angulated distal implants is balanced by 17-degree angled abutments. After transferring the implant position to the dental laboratory, the prepared restoration was finalized. The remaining teeth were extracted and the temporary restoration was delivered 3 h after implant placement. The definitive fixed full-arch zirconia restoration with micro layering was placed 9 months later in a stable situation. Conclusion: The remarkable accuracy of the implant placement with a surgical template generated from preoperative virtual implant planning ensures a relatively short treatment time and an uneventful and fast recovery with minimal discomfort. The immediate prosthodontic rehabilitation is a benefit, not only for the patient but also for the dental team. Micro-layered monolithic zirconia seems to be a promising option for screw-retained full-arch prostheses. Keywords: guided implant surgery, edentulous jaw, backward planning, immediate function, digital workflow

The tasks of Working Groups 1 to 6 at the 4th Consensus Meeting of the Oral Reconstruction Foundation were to elucidate clinical recommendations for implant-supported full-arch rehabilitations in edentulous patients. Six systematic/ narrative reviews were prepared to address the following subtopics: (1) the influence of medical and geriatric factors on implant survival; (2) the prevalence of peri-implant diseases; (3) the influence of material selection, attachment type, interarch space, and opposing dentition; (4) different interventions for rehabilitation of the edentulous maxilla; (5) different interventions for rehabilitation of the edentulous mandible; and (6) treatment choice and decision-making in elderly patients. Consensus statements, clinical recommendations, and implications for future research were determined based on structured group discussions and plenary session approval.

Für den Erfolg in der ästhetischen Zone spielt die Weichgewebearchitektur eine entscheidende Rolle. Als weiteren wichtigen Faktor ist die Positionierung des Implantates zu berücksichtigen. Hierfür kann eine digitale Planung und geführte Implantatinsertion für den Kliniker empfohlen werden. Bei ausgeprägten körperlichen Fehlpositionierungen in orofazialer und koronoapikaler Ebene lässt sich eine Explantation und Neuversorgung nicht vermeiden. Bei weniger ausgeprägten Fehlpositionierungen kann ein kombiniert prothetisch-chirurgisches Therapiekonzept für die ästhetische Rehabilitation um Implantate gewählt werden und somit ein ästhetisch ansprechendes Ergebnis mit sehr guter Prognose für einen langfristigen Erfolg erzielt werden. Keywords: Digitale Implantatplanung, Bindegewebetransplantat, Augmentation, Implantation, Sofortimplantation, Ästhetik, Einzelzahn, Komplikationsmanagement, Weichgewebearchitektur

Die dreidimensionale Position des Implantats ist ein wichtiger Prognosefaktor für Implantate im Frontzahnbereich. Für die Planung und Umsetzung der Position stehen heute moderne dreidimensionale bildgebende Verfahren und entsprechende Planungssoftwares zur Verfügung. Schon länger können geplante Implantatpositionen in industriell gefertigte Schienen übertragen werden, die ein geführtes Implantieren erlauben. Neu ist die Möglichkeit, Oberflächenscans von Wachssimulationen und Set-ups mit den Datensätzen zu vereinen und so nach restaurativen Bedürfnissen planen zu können. Auch digitale Set-ups sind realisierbar. In dem Beitrag werden verschiedene Möglichkeiten zur digitalen Implantatplanung vorgestellt und die Optionen diskutiert. Keywords: Implantologie, Frontzahnimplantat, Implantatposition, digitale Volumentomographie, CAD/CAM-Implantatschablone, 3-D-Druck, Komplikationen

Three-dimensional (3D) implant positioning is an important prognostic factor for anterior dental implants. Modern 3D imaging and implant treatment planning systems are available today for precise dental implant planning and placement. The transfer of implant position information to industrially manufactured templates for guided implant surgery has been possible for years now. What is new is the possibility of combining the datasets with the surface scan data of a diagnostic wax-up and setup for prosthetic-driven implant planning. Digital setups can also be used. This article describes and discusses the available options for digital implant planning and guided surgery. Keywords: dental implantology, anterior implant, implant position, cone beam computed tomography, CAD/CAM surgical guide, 3D printing, complications

Oft diskutiert und doch nicht abschließend geklärt ist die Art der Verbindung bei festsitzenden Implantatrestaurationen. Grundsätzlich kann zwischen zementiert oder verschraubt gestalteten Versorgungen unterschieden werden. Aufgrund des Risikos, dass Zementreste im Sulkus verbleiben, empfiehlt es sich, bei der zementierten Therapievariante individualisierte Abutments zu nutzen. Vor allem im Frontzahngebiet werden hiermit bei einer für die Verschraubung ungünstigen Implantatachse ansprechende Ergebnisse erzielt. Die verschraubten Implantat-restaurationen lassen sich im Bedarfsfall leicht entfernen und zeigen mit der Sinterverbundtechnik ästhetisch, biologisch und mechanisch hervorragende Resultate. Bei korrekter Anwendung ist keine der beiden Therapievarianten überlegen, und die Entscheidung, welche zum Einsatz kommt, hängt von der Präferenz des behandelnden Zahnarztes ab. Keywords: Verschraubte Implantatrestauration, zementierte Implantatrestauration, Sinterverbundkrone, individualisiertes Abutment, Chipping

Die digitale Technologie sorgte in den vergangenen beiden Dekaden für fundamentale Änderungen der Behandlungsabläufe in der restaurativen Therapie. Vor allem ins zahntechnische Labor zogen neue Materialien und neue Fertigungstechniken ein. Da Implantate für Zahnersatz höhere Anforderungen in puncto mechanischer Belastbarkeit und Genauigkeit stellen, kann hier die digitale Technik ihre Stärken ausspielen. Bei Einzelzahnrestaurationen auf Implantaten kann inzwischen auf den sog. kompletten digitalen Workflow zugegriffen werden, d. h. es wird kein physisches Modell mehr benötigt. Werden Implantate miteinander verblockt, wird die Herausforderung an die Fertigungskette deutlich komplexer. Hier stellt die klassische Abformtechnik mit der Digitalisierung im zahntechnischen Labor das Standardverfahren dar. Natürlich kann die digitale Technik auch im konventionellen Arbeitsablauf eingesetzt werden und kleine analoge Anteile ersetzen. Der Artikel soll die verschiedenen Arbeitsabläufe in der Implantatprothetik und den Einsatz der CAD/CAM-gefertigten Suprakonstruktionen darstellen. Keywords: CAD/CAM, digitale Fertigung, Suprakonstruktion, Implantatprothetik, Einzelzahnkrone, Brücke, Steg

The primary objective of implant insertion is optimal prosthetic implant positioning while simultaneously protecting sensitive anatomical structures. In this context, navigated implants show significantly better results than freehand-inserted implants. Computer-assisted navigation, in combination with three-dimensional (3D) imaging by cone beam computed tomography (CBCT), is an ideal way to achieve higher predictability for successful implant therapy. Basically, one can distinguish between static navigation using templates, and direct dynamic navigation using optical transmission systems. Both options demonstrate comparably good results as far as the precision of implant positioning is concerned. Today, the gold standard is digital manufacturing of the template. Direct navigation is the more attractive option, provided acquisition costs can be reduced by simplifying the system. This article presents patient cases that demonstrate different variants of navigated implantology. Keywords: static navigation, dynamic navigation, digital manufacturing, template, CAD/CAM, reference marker