Cas cliniques
Dr Philippe
COLIN
Montpellier - France
Mr Fabio
LEVRATTO
Dental lab in Monaco
Axiom® BL (Bone Level) implant and inLink® abutment: relevance in extended rehabilitation
A 53-year-old patient, in good health. Consultation following mobility of residual teeth. Functional and Aesthetic requirement. Does not want a removable prosthesis. Chronic severe periodontitis evolving in a strong prosthetic context on genetic predisposition with no significant risk factors. A multidisciplinary treatment is proposed.
1- Situation at first consultation: Loss of posterior VD and absence of anterior contact with lingual interposition and protrusion.
2- Pre-operative panoramic X-ray.
3- Wax model resulting from aesthetic analysis.
4- Insertion of a temporary bridge during avulsion of Non-recoverable teeth. This bridge allows the sinus lift grafts to heal and osseointegration to develop naturally. It is based on 17, 13, 11, 21 and 23. Apart from 17, they will be extracted at the time of loading.
5- Axiom® BL (Bone Level)/PX implant in place in sector II The cortical blocks are visible 6 months after the graft.
6 – Healing screws sector II.
7- Healing screws 4 months after insertion.
8- Condition of soft tissues upon placement of screws in sector II, just before insertion of inLink® abutments.
9- Temporary 25° angulated cylinders are selected to orient toward the palate the screw channels to the lock. A new temporary bridge will be designed. It will be the prototype of the permanent prosthesis.
10- Palatine emergence of the lock access channels in sector II. On 26, the angulation is not sufficient for a totally palatal emergence, and a right side occlusal emergence will be chosen for the permanent prosthesis.
11 – Anterior inLink® abutment and alveolar management after extraction of incisives and canines.
12- Second temporary bridge on inLink® abutment.
13- Back side of resin bridge. The trial inLink® locks are still in place.
14- Impression transfers in place. inLink® abutments 4.8 mm platform have been chosen for the back and 4 mm for 12 and 22. The transfers will be solidified before polyether impression.
15- Working model with analogues. The placement of the temporary bridge on this model allows validation and recording of the emergence of profiles, vestibular and palatal contours and to carry out the installation on the articulator.
16- Wax model of the silicone keys of the temporary bridge. Among other things, the prosthetist can only make an evaluation when the free edge of the incisives and the frontal aesthetic plan are fixed.
17 – CAD concept image of the Simeda® frame: the screw channels in yellow and the implant axes in blue show the angulation of the screw channels.
18 – Full Zircone Simeda® bridge. The access channels to the locks are oriented toward the palate with a 25° angulation except on 12, 22 and 26.
19- Occlusal view of the inLink® abutments before bridge insertion.
20 – Permanent bridge. Only the vestibular sides are enamelled. The palatal and occlusal sides are full Zircone. This bridge represents the nearly identical copy of the provisional wax model.
21- A retroalveolar panoramic X-ray at the end of treatment confirms bone stability around the implant neck.
22- Our patient’s smile at the end of treatment, developed over 2 years.
Conclusion
This multidisciplinary treatment has required close collaboration between the practitioner and the dental technician. The industry’s constant innovations make some steps easier with reliable solutions. Here, the placement of the inLink® connection with an angulated access channel allows the holes to be moved on the palatal sides, outside the functional occlusal areas. It’s a real clinical progress once the implant path is vestibular.
