REHABILITATION USING A VARIO SR COMPONENT ON A TILTEDIMPLANT.Dr Henning BastianSlotsgade 18, 2.5000 OdenseDenmarkContact address: firstname.lastname@example.orgSUMMARYThis case shows the use of a tilted implant to avoid sinusinvolvement and a region with only a small amount ofbone. This case was restored quite simply using a CamlogVario SR component.Dr Bastian graduated as a dentist in 1971 from the dental schoolat Århus University, Denmark and specialized in Oral andMaxillo-Facial Surgery in 1986 from Odense University Hospital.Dr Bastian was Head of the Department of Oral and Maxillofacial Surgery at Odense UniversityHospital 1988-2010. He was Ass. Professor in Oral Medicine and Oral Pathology at Odense andÅrhus University. Since 1977 he has been Forensic Odontologist at the Department for ForensicMedicine, Odense University. He is Editor in Chief of the Danish internet sitewww.tandogmund.dk-2000. Since 2009 he has been a Member of the Camlog Expert Panel and since2010 in private pratice in Oral and Maxillofacial Surgery in Odense, Denmark.
INTRODUCTIONA 48 year old man avoided recommended treatment for a decade. When he returnedthe situation had become quite bizarre with “implants” placed overseas to maintainan existing failed bridge. It was necessary to completely re-formulate the treatmentplan.CURRENT SITUATIONThere was pain in the region about the bridge. A foul odor emitted from the areaand the bridge was tender to percussion. A radiograph showed that the distaltooth was completely periodontally involved and that the bridge was separatedfrom the anterior abutment, which had . All that was maintaining the bridge inposition were two screws placed through the bridge.The patient’s general health was good. He was not taking any medications and hehad no history of allergies.TREATMENT PLANIt was necessary to remove the bridge, and the teeth which had been supportingit. After a period of healing, implants would be placed to support a newrehabilitation.
Fig. 1A 48 year old man had pain and bad odor from around an old bridge, due to advanced periodontalbreakdown. 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 thepremolar 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 patientwas 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. Theplan 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. 6Two months later, the implants are tested clinically with torque and percussion tests. All showgood osseointegration. We are now ready to take an implant-level impression for the ﬁnal bridge.
Fig. 7At the start of the prosthetic treatment. Notice the ﬁne gingival response around the gingivaformers.
Fig. 83.8 mm Camlog Open-Tray impression posts are used for the impression.
Fig. 9The 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 aa Camlog 200 Vario SR abutment.
Fig. 11The ﬁnal bridge secured in place with the access screwholes ﬁlled by resin composite. The ﬁnalresult fullﬁlls the functional and cosmetic requirements very well.
Fig. 12A composite radiograph of the ﬁnal bridge in place. Notice the healthy bone line about the implants.
DISCUSSIONThis case could have been treated in several different ways. The patient wantedthree 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 accounttreatment time, morbidity, costs, bone quality, and long time survival rate for theimplants.The patient wanted to avoid an open sinus lift because of the extended treatmenttime 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 tothe optimal loading conditions and the well-known problems with a distalextension.
CONCLUSIONDentists should be aware that tilted implants can be very useful in the rightsituation. In this case, the use of a tilted implant allowed the patient to avoid anopen sinus lift procedure and to reduce the treatment time by six months.By use of VarioSR system components the angulation of the implant could easilybe overcome and the restorative process was made very simple.Overall, the treatment was turned from “complex” to “straightforward” in a veryelegant way.