REHABILITATION USING A VARIO SR COMPONENT ON A TILTED IMPLANT.Dr Henning BastianSlotsgade 18, 2.5000 OdenseDenmark

Dr Bastian graduated as a dentist in 1971 from the dental school at Århus University, Denmark and specialized in Oral and Maxillo-Facial Surgery in 1986 from Odense University Hospital.

Contact address: hlb@os.dkSUMMARYThis case shows the use of a tilted implant to avoid sinus involvement and a region with only a small amount of bone. This case was restored quite simply using a Camlog Vario SR component.

Dr Bastian was Head of the Department of Oral and Maxillofacial Surgery at Odense University Hospital 1988-2010. He was Ass. Professor in Oral Medicine and Oral Pathology at Odense and Århus University. Since 1977 he has been Forensic Odontologist at the Department for Forensic Medicine, Odense University. He is Editor in Chief of the Danish internet site www.tandogmund.dk-2000. Since 2009 he has been a Member of the Camlog Expert Panel and since 2010 in private pratice in Oral and Maxillofacial Surgery in Odense, Denmark.

INTRODUCTIONA 48 year old man avoided recommended treatment for a decade. When he returned the situation had become quite bizarre with “implants” placed overseas to maintain an existing failed bridge. It was necessary to completely re-formulate the treatment plan.

CURRENT SITUATION

There was pain in the region about the bridge. A foul odor emitted from the area and the bridge was tender to percussion. A radiograph showed that the distal tooth was completely periodontally involved and that the bridge was separated from the anterior abutment, which had . All that was maintaining the bridge in position were two screws placed through the bridge.

The patient’s general health was good. He was not taking any medications and he had no history of allergies.

TREATMENT PLAN

It was necessary to remove the bridge, and the teeth which had been supporting it. After a period of healing, implants would be placed to support a new rehabilitation.

Fig. 1A 48 year old man had pain and bad odor from around an old bridge, due to advanced periodontal breakdown. The treatment plan was to remove the molar but the patient did not return for therapy.

Fig. 2Ten years later, he returned in severe pain. An x-ray showed the bridge had separated from the premolar abutment and that screws (implants?) had been placed in the bone and into the sinus.

Fig. 3The treatment plan was changed. The bridge with all three teeth needed to be removed. The patient was then referred to me for implant treatment.

Fig. 4The situation after the removal of the bridge. Notice the missing bone in the first molar region. The plan is to place three implants with the most distal being tilted mesially.

Fig. 5. The three implants avoided the problem with the missing bone and any need for sinus augmentation. 3.8 x 11mm Camlog Screwline PromotePlus implants were placed (9mm for the second premolar).

Fig. 6 Two months later, the implants are tested clinically with torque and percussion tests. All show good osseointegration. We are now ready to take an implant-level impression for the final bridge.

Fig. 7 At the start of the prosthetic treatment. Notice the fine gingival response around the gingivaformers.

Fig. 8 3.8 mm Camlog Open-Tray impression posts are used for the impression.

Fig. 9 The tray is perforated to allow access to the impression posts to retract the stabilization screws.

Fig. 10The impression prior to having implant analogs attached. The distal molar will be restored with a a Camlog 200 Vario SR abutment.

Fig. 11 The final bridge secured in place with the access screwholes filled by resin composite. The final result fullfills the functional and cosmetic requirements very well.

Fig. 12 A composite radiograph of the final bridge in place. Notice the healthy bone line about the implants.

DISCUSSION

This case could have been treated in several different ways. The patient wanted three teeth. The treatment options were as listed below:

#1. Open sinus lift 16 and two implants 16,14 with a 3-unit bridge.#2. Two implants 15,14 with a two-unit bridge with a distal extension.#3. Open sinus lift and three implants 16,15,14 with a three-unit splint.$4. Three implants 17 (tilted) ,15,14 with a four-unit bridge.

These four treatment options needed to be compared taking into account treatment time, morbidity, costs, bone quality, and long time survival rate for the implants.

The patient wanted to avoid an open sinus lift because of the extended treatment time and the risk of postoperative morbidity.

So the choice came down to being between options #2 and #4.

As a professional, I recommended the patient to have option #4 with respect to the optimal loading conditions and the well-known problems with a distal extension.

CONCLUSION

Dentists should be aware that tilted implants can be very useful in the right situation. In this case, the use of a tilted implant allowed the patient to avoid an open sinus lift procedure and to reduce the treatment time by six months.

By use of VarioSR system components the angulation of the implant could easily be overcome and the restorative process was made very simple.

Overall, the treatment was turned from “complex” to “straightforward” in a very elegant way.

Tak