Comprehensive case in a periodontally compromised patient.

A comprehensive case treated by PD Dr. Ronald Jung at the University of Zurich.

Soft tissue management is an essential part of successful implant treatment. In this module, the aspects of soft tissue management previous to and simultaneous with implant placement are discussed.

The old restorations showed several ceramic fractures and in some areas the framework was exposed. The patient's main concern was the unesthetic appearance of the anterior crowns in the maxilla due to these chippings.

A central incisor with reduced attachment and an old FDP in the aesthetic zone had to be replaced in a man with a medium lip line. The case was treated in the private office of Dr. Dominik Büchi, Chur, Switzerland.

Procedure: - Presentation of procedure for immediate implant loading in the edentulous mandible according to the Ledermann concept - Surgical implantation of XIVE® TG implants - Bite registration and impression-taking - Presentation of prosthetic components - Fitting and passive fixation of the mesostructure in the mouth - Integration procedure Contents: This video demonstrates the extraction of teeth in a partially dentate mandible followed by immediate loading of six XIVE® TG implants. Following the Ledermann immediate loading concept, a mesostructure will be used for tension-free primary interlock in this special case. Bridge-like lower full dentures with plastic teeth will then be inserted on this frame and retained with an occlusal screw. Since the dentures can only be removed by the dentist, they are \fixed\ as far as the patient is concerned. This simple and quickly produced yet extremely well-fitting restoration, which requires only minimal time and effort for the implant components, is the subject of this contribution.

Procedure: - Incision Technique and Roll Flap Creation - Excision and Transplantation of Connective Tissue Graft Material from the Palate - Implant Placement and Fixation Procedure Contents: This video describes the preparation of an implant insertion site for placement of an individual implant at site 11 using a roll flap and free connective tissue graft technique. The procedure is designed to shape the implant insertion site and to create a secure, keratinized gingival base. Step-by-step, the operator demonstrates the incision technique, the roll flap creation procedure and the techniques used for excision, transplantation and fixation of the free connective tissue graft within the scope of implant placement.

Procedure: - Topographic anatomy of the palate - Localization of the palatal implant site - Surgical insertion of the palatal implant - Surgical insertion of the cortical screws - Examples of the orthodontic devices Materials: Palatal Implant (Straumann, Orthosystem) and Screw (Aarhus System, Medicon)

Contents: - Surgical procedures for anchoring a diagnostic guide - Inserting four provisional implants - Impression and bite registration, fabrication of the master cast - Tooth-setup for the temporary restoration - Registering the setup in a silicone index - Duplicating the setup in radiopaque resin for CT imaging - Implant planning using a 3D record of the CT image - Fabricating a transfer template based on the CAD treatment plan using the CAMLOG® Guide System - Inserting the guiding sleeves into the template - Fabricating the final restoration prior to inserting the implants - Vario SR abutments with Vario SR titanium copings for a passive fit - Fabricating a cast titanium framework to reinforce the restoration - Surgical procedures demonstrating the definitive implant insertion - Insertion of six implants for immediate loading - Providing a controlled-clearance fit between the implants and the denture base