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Ziel dieses Artikels ist die Darstellung der unterschiedlichen Indikationen und des Herstellungsprozesses individueller CAD/CAM-gefertigter Gingivaformer und korrespondierender Abformpfosten aus PEEK anhand verschiedener Fallbeispiele. Individuelle Gingivaformer und korrespondierende Abformpfosten können sowohl präoperativ nach geführter Implantatplanung mittels DVT-Datensatz (Dicom-Daten) und digitaler Abformung (STL-Daten) als auch post implantationem nach intraoperativer digitaler Registrierung der Implantatpositionen gefertigt und eingesetzt werden. Mithilfe individueller Gingivaformer können das Weichgewebe und das Emergenzprofil ohne aktiven Druck ausgeformt werden. Dies führt sowohl bei der Sofortimplantation als auch bei der Implantatfreilegung zu einer deutlichen Verbesserung des funktionellen und ästhetischen Endergebnisses. Durch den Einsatz individueller Gingivaformer und korrespondierender Abformpfosten kann ein aufwendiges evtl. schrittweises Ausformen der Weichgewebe unter aktivem Druck mittels Implantatsuprarekonstruktion umgangen werden. Manuskripteingang: 19.05.2022, Annahme: 18.07.2022 Keywords: ästhetische Implantologie, Weichgewebeausformung, individuelle Gingivaformer, individuelle Abformpfosten, PEEK

Purpose: To assess whether material choice for the prosthetic component of an implant restoration influences the failure mode in case of occlusal overload in monolithic restorations fabricated from high-strength ceramics on titanium implants. Materials and Methods: Within this pilot study, finite element analysis (FEA) was conducted to simulate stress and deformation of implant-supported crowns fabricated from lithium disilicate (LiS2) and zirconia (3Y-TZP). Additionally, an in vitro load-to-failure test was conducted using two specimens per group to evaluate the failure mode and to confirm the findings from the FEA. Results/ Conclusion: FEA revealed stress areas at the palatal cervical areas of the crowns. In the load-to-failure test, both LiS2 hybrid abutment crowns fractured (410 N and 510 N) before plastic deformation of the metal implant components could be detected. The 3Y-TZP monolithic hybrid abutment crowns did not fracture until the tests were interrupted at 646-N and 690-N occlusal force, when plastic deformation of the metal implant components was visually observed.

Purpose: To retrospectively compare the incidence of biologic and prosthetic complications in implantsupported fixed dental prostheses (FDP) and removable dental prostheses (RDP) in edentulous patients after up to 10 years. Materials and Methods: A total of 13 patients (mean age: 58.8 years, women = 9, men = 4) who had received 14 implant-supported FDPs and a total of 43 patients (mean age: 64.4 years, 22 women, 21 men) who were provided with 50 implant-supported RDPs were included in the study. The RDPs were fixed using locator attachments, ball heads, bars, or double-crowns. Technical, biologic, and prosthetic complications were assessed over a 73.3-month (± 37.7) follow-up period, and the collected data covered the period between 2000 and 2016. Using Kaplan-Meier curve and Breslow tests, the data were statistically analyzed. The level of peri-implant bone margins was determined at least every 2 years. Results: Of the 328 implants placed, 2 had to be removed during the follow-up period. All implant superstructures were still in situ at the end of the observation period. The mean overall complication rate was 0.24 per restoration per year for FDPs and 0.37 per year for RDPs. Reasonable therapeutic interventions allowed for preserving and reestablishing the integrity of all implants and full operability of all superstructures. Prosthetic complications occurred about four to five times more frequently than biologic ones; however, according to Breslow test, the distribution of biologic and prosthetic complications was not significantly different (P > .05) when comparing FDPs and RDPs over 10 years. Conclusion: Implant-supported FDPs were not significantly more prone to complications than implant-supported RDPs over time. Prosthetic intervention was required more often than biologic interventions in both approaches.

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

Die präimplantologische Rekonstruktion des Alveolarfortsatzes bei komplexen horizontalen und vertikalen Alveolarkammdefekten stellt eine große Herausforderung dar. Bei dreidimensionaler Knochenaugmentation mit ausgeprägter vertikaler Komponente wird als Goldstandard der Einsatz von extraoral entnommenen Knochenblöcken aus der Beckenkammregion angesehen. An drei Fallbeispielen werden alternativ die Einsatzmöglichkeiten der Schalentechnik mit autologen, xenogenen und synthetischen Materialien dargestellt. Als vorteilhaft haben sich dabei die Erweiterung von Behandlungsoptionen zur Weich- und Hartgewebeaugmentation und die Senkung der Entnahmemorbidität für Patienten erwiesen. Allerdings fehlen noch Langzeitstudien zum Implantatüberleben, zu den Augmentatresorptionsraten und zum marginalen periimplantären Knocherverlust. Auch welches Material für die Schale und die entsprechende Füllung bevorzugt werden soll, ist nicht abschließend geklärt. Manuskripteingang: 24.08.2021, Annahme: 23.09.2021 Keywords: dreidimensionale Knochenaugmentation, Schalentechnik, SonicWeld Rx, allogene Biomaterialien, xenogene Biomaterialien, azelluläre dermale Matrix

Die Anzahl an Einzelzahnimplantaten steigt in den letzten Jahren stetig an, sodass sich deren Suprakonstruktionen für ein breites Patientenspektrum unter anderem im Hinblick auf Langlebigkeit, Ästhetik und Funktion mehr denn je bewähren müssen. Gerade die Kombination aus CAD/CAM-Technologie und neuen Restaurationsmaterialien ermöglicht innovative und effiziente Therapieansätze für implantatgetragene Einzelzahnrestaurationen. In diesem Übersichtsartikel werden sogenannte „Hybridabutments“ und „Hybridabutmentkronen“ als mögliche Versorgungsalternativen eingeordnet und bewertet, die teilweise – je nach Indikation und Workflow – ein volldigitales, modellfreies Arbeiten versprechen. Auch rücken neue prothetische Konzepte die kontroverse Diskussion Verschraubung vs. Zementierung der Suprakonstruktion in den Fokus. Ein weiterer Aspekt ist die Frage nach dem biomechanischen Verhalten insbesondere von monolithisch gefertigten Hybridabutmentkronen und dem bestmöglichen Versagensmuster. Somit sollen der implantatgetragene Einzelzahnersatz auf Titanklebebasen kritisch erörtert und die möglichen Vorteile und Erfolgsfaktoren gegen Limitationen und Fehlerquellen abgewogen werden. Manuskripteingang: 21.06.2021, Annahme: 12.08.2021 Keywords: Einzelzahnimplantat, Hybridabutment, Hybridabutmentkrone, digitaler Workflow, CAD/CAM, Implantat-Abutment-Verbindung, Verschrauben, Zementieren

In many areas of restorative dentistry, metal-free materials offer an alternative to metal-based restorations while ensuring high levels of biocompatibility and esthetics. Rapidly evolving CAD/CAM technology has significantly expanded the range of materials available, providing access to materials classes and their combinations not previously available within conventional manufacturing, such as zirconia ceramics and hybrid ceramics. In addition, digital methods offer previously unavailable options in diagnostics, greater planning reliability, better material quality through standardization of the manufacturing process, and reproducibility - significant benefits that can be used to advantage, especially in oral implantology. Even though technological progress in the field of metal-free materials has given rise to considerable improvements in their mechanical properties over the decades, their clinical long-term success is still very much dependent on an appropriate indication and proper material selection, on the knowledge and skills of the dental practitioner and dental technician, and on an adequate occlusion concept. The high rate of innovation - both with regard to the materials themselves and to CAD/CAM technology - therefore requires an adequate level of prior knowledge to sensibly and successfully implement the wide range of possibilities. It is becoming more and more puzzling for users to find their way around the many different new techniques and materials. This review article provides an up-to-date overview of the possibilities and limitations of metal-free implant-supported single-tooth restorations. This second part discusses hybrid abutment crowns and materials selection. Resultant treatment concepts are presented and evaluated based on clinical examples.

In many areas of restorative dentistry, metal-free materials offer an alternative to metal-based restorations while ensuring high levels of biocompatibility and esthetics. Rapidly evolving CAD/CAM technology has significantly expanded the range of materials available, providing access to materials classes and their combinations not previously available within conventional manufacturing, such as zirconia ceramics and hybrid ceramics. In addition, digital methods offer previously unavailable options in diagnostics, greater planning reliability, better material quality through standardization of the manufacturing process, and reproducibility - significant benefits that can be used to advantage, especially in oral implantology. Even though technological progress in the field of metal-free materials has given rise to considerable improvements in their mechanical properties over the decades, their clinical long-term success is still very much dependent on an appropriate indication and proper material selection, on the knowledge and skills of the dental practitioner and dental technician, and on an adequate occlusion concept. The high rate of innovation - both with regard to the materials themselves and to CAD/CAM technology - therefore requires an adequate level of prior knowledge to sensibly and successfully implement the wide range of possibilities now open. It is becoming more and more puzzling for users to find their way around the many different new techniques and materials. This review article provides an up-to-date overview of the possibilities and limitations of metal-free implant-supported single-tooth restorations. This first part discusses abutments and cemented crowns. Resultant treatment concepts are presented and evaluated based on clinical examples. Keywords: abutments, CAD/CAM, hybrid abutments, implant prosthetics, implant-supported crowns, lithium disilicate, lithium silicate, monolithic restorations, polymers, titanium adhesive bases, zirconia, zirconium oxide

Metallfreie Materialien bieten in vielen Bereichen der restaurativen Zahnheilkunde eine Alternative zu metallbasierten Versorgungen, bei gleichzeitig hoher Biokompatibilität und Ästhetik. Die sich rasant weiterentwickelnde CAD/CAM-Technologie hat die Materialvielfalt erheblich erweitert und ermöglicht heute den Zugang zu Materialklassen und -kombinationen, die in herkömmlichen Herstellungsverfahren nicht zugänglich wären. Die hohe Innovationsrate bei den verfügbaren Materialien und der CAD/CAM-Technologie setzt ein besonderes Maß an Vorkenntnissen voraus, um die weit gefächerten Möglichkeiten sinnvoll und erfolgreich umsetzen zu können. Dieser Beitrag gibt einen aktuellen Überblick über die Möglichkeiten und Grenzen metallfreier implantatprothetischer Einzelzahnversorgungen auf Implantaten. Daraus entwickelte Behandlungskonzepte werden anhand von klinischen Anwendungsbeispielen dargestellt und bewertet. Keywords: Implantatprothetik, Lithium(di)silikat, Zirkonoxid, CAD/CAM, Abutments

This case report introduces a temporary denture with reduced extension stabilized in the edentulous maxilla as a possible treatment method for patients with a severe gag reflex, allowing them to test the function, esthetics, and tolerance of the denture prior to hard tissue augmentation and implant placement. A 4-mm implant was placed in the central anterior palate and allowed to heal for 3 months. During the complete treatment period, a denture with reduced extension can be delivered on a fixed Locator abutment. This method was successfully applied in three patients, and the palatal implant remained stable until the final removable prosthesis could be delivered.