Dr. Ufuk Adali
ALL CLINICAL CASES
The Purpose was to demonstrate, how intraoral scanning devices can help to manufacture a double-crown supported removable dental prosthesis for a patient with microstomia. And how damaged implants could be used again, if there is no other option. Photography was only limited possible, due the microstomia.
Case:
Picture 1: In August 1988, the 63-year old patient M. was seriously injured by an air strike in Lebanon. After receiving primary medical care, he escaped to Germany and in 1992 he got a reconstruction of the mandible using an iliac crest transplant, several labioplastics and implants in the mandible. The intraoral examination revealed the residual teeth 24, 25, 26 and 27 (FDI position) and Implants in regio 35, 41 and 43. The patient’s request was the rehabilitation of the maxilla and mandibula using removable dentures without further additional implants. 
2: Due to scar-tissue caused by multiple surgeries in the oral region the maximum mouth opening of the patient was limited to 25 mm (vertical) and 40 mm (horizontal). The mouth opening did not allow to place a conventional impression tray in the maxilla to make a conventional impression.3: Teeth 24 and 25 had multiple issues and were irrational to treat. So they were removed.
4: All Implants showed severe bone loss and parts of the implant-shoulder of implant 35 and 41 were fractured. The Surgery did not want to remove or set new implants due the very thin iliac crest transplant in the mandible.5: Teeth 26 and 27 were prepared for telescopic double crowns with additional friction elements.6: An intraoral scan of the teeth was taken with a powder-free scanning device7: The primary crowns were designed with a CAD-program and got afterwards milled.8: In the next appointment a functional impression was necessary, to collected the primary crowns, however, the microstomia ruled a conventional impression out in the maxilla. Therefore an intraoral scan of the soft tissues and the primary crowns was performed.9: The fabrication of the removable denture prosthesis was carried out on milled casts manufactured of the data from the scans. The bite record for the vertical dimension and centric relation was fabricated on these casts. After designing the prosthesis in wax and a try-in the dental laboratory technician finished the removable denture prosthesis10: The primary crowns were bonded to the teeth with a self-adhesive composite material. To compensate limitations of accuracy reproducing the alveolar mucosa the removable denture prosthesis was relined using an impression material with low viscosity. 11: The intraoral situation with the fractured implants in regio 35 and 41.12: These Implants were prepared and polished to get a post-supported magnetic attachment.13: After designing the prosthesis in wax and a try-in the dental laboratory technician finished the removable denture prosthesis.14: The magnetic post-attachments were adhesively luted to the prepared implants in regio 35 and 41. The magnetic abutment (45) was screwed in.15 the finished removable denture prostheses
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