The use of Arcsys System in challenging condition

AUTHORS : Prof. Rafael Cury Cecato Prof. Thiago Roberto Gemeli

COMPLAINT
Absence of elements 14 and 16. Rehabilitation of these regions without subjecting the patient to teeth extraction and/or orthodontic treatment.

ANAMNESIS
Patient’s health is compatible with the proposed treatment.

PLANNING
Installation of implants in the place of elements 14 and 16 respecting adjacent root inclination. Compensation of these angles with Arcsys foldable prosthetic components.

INTRODUCTION:
It is a consensus that prosthetic planning is highly important facing a rehabilitation1,2 case. However, when identifying that the situation is not favorable to the stablished planning, the dentist
must look for alternatives, in a way as to maintain the original programing and not compromise the final result1,3.

Such alternatives cover pre-operatory procedures that are consistent with preparing the region in which the rehabilitation will occur, as for example, enough space in the bone tissue to anchor the
implant that will support the restoration, regarding its dimensions as much as inclination and location that are compatible with the planning’s outline. We can mention as resources, orthodontic movements, grafting surgeries, separation of nerves/vases or even extraction of the teeth. The cost benefit relation must guide the professional during this decision, always having in mind that the
rehabilitation must be conducted with the premise that it will cause the least trauma possible, shorter time of treatment and lower financial cost.

Arcsys Implant System has innovative characteristics so that the dentist can aim at carrying out his/her rehabilitation in a more agile way, but not necessarily less successful biologically, mechanically or aesthetically. Such resourcefulness is found in the prosthetic components folding capability, be it for screw- or cement-retained prosthesis, in accordance with the planning, and without hurting the component’s functional and aesthetics characteristics. In the clinical case that will be presented now, the challenge is to rehabilitate the right posterior superior sextant replacing the missing teeth 14 and 16, without subjecting the patient to previous orthodontic treatment neither extract teeth that are considered to be biomechanically adequate.

TREATMENT:
The patient is a 57-year old female individual, with main complaint of absence of two superior teeth on the right side (Figs. 1 and 2). The prosthetic spaces were consistent with the manufacturing of prosthetic crowns for elements 14 and 16. However, during the analysis of the radiographic images, it is learnt that the implants could not be installed with their long axis coinciding with the prosthetic crowns long axis (Fig. 3).

As previously related, during the case-study it was requested that no viable maintenance tooth were extracted and the patient did not demonstrate to be willing to consider orthodontic treatment. However, on the contrary of what several colleagues would consider in face of this scenario, the solution is simple and practical as long as a rehabilitation system that possesses the required
demands is used. Facing this, the Arcsys System, was chosen. The main reason for this choice was the possibility to compensate the angles in which the devices would necessarily be installed. On this matter Arcsys in unbeatable since no other system allows to fold the prosthetic component up to 20o without damaging the rehabilitation mechanical and aesthetical response4,5,6.

During the perforation, surgical radiographies were taken to ensure its path and consequently the integrity of the adjacent teeth roots (Figs. 4 and 5). Element 15 endodontic treatment was carried out immediately after the installations and its control suggest a regression of the infectious process.

After waiting 90 days, the prosthetic components for unitary cement-retained prosthesis were selected (Arcsys 3x4x3.5mm abutment for cement-retained restoration for element 14 and 4.2x6x3.5mm abutment for cement-retained restoration for element 16), folded with the aid of Angle Referrers (Figs. 6 to 9) and placed (Figs. 10 and 11). Note that path compensation is relatively small
(6o and 7o), however essential in the construction of the prosthetic restorations with anatomic and aesthetic excellence. After this moment, tissue conditioning was started with temporary prosthesis to mimic the concave arch surrounding the implants (Figs. 12 to 14).

The porcelain crowns (lithium disilicate) were cemented with notable care in order to remove the excess with an analog of the prosthetic components out of the mouth and immediately before placing the intermediaries. Therefore, the restoration of element 15 was replaced (Figs. 15 and 16).

During the observation period (seven months), one can clearly see the stability of peri-implantar tissues, made possible by, among other factors, intended bacterial sealing in the conic frictional connection (“real” Morse taper), proper placing of the devices (implant/component/restoration) concerning adjacent teeth and adjusted occlusion according to treatment demands (Fig. 17).

CONCLUSION:
With extraordinary resources, inconceivable not long ago, however available now to dentists and dental prosthesis technicians, it is perfectly possible to transform seemingly complex rehabilitation
procedures, in perfectly simple and viable treatments. This possibility also increases significantly the perspective of dental implants rehabilitation success and becomes an essential tool for every oral rehabilitator professional.