[Implant-ceramometal prosthesis relation: esthetic and technical improvements]

Two major concerns characterize the difficulties encountered with prostheses on implants. 1--The difference in orientation between the implant, imposed by anatomical requirements, and the restoration anatomy. It should be kept in mind that a sufficient occlusal space is required to house the restoration. The regularization of the occlusal curve of the opposite arch, in the example given, was obtained by bonding ceramic overlays. 2--The visibility of the abutment at the gingival level. In this clinical case, after removing the old prosthesis, it is observed that the position of the screws is unsuitable, as one of them emerges into the embrasure. A solution to these problems may be found in building an intermediate screwed core. The technical protocol requires the use of long screwed transfers, a specific impression method and plastic preforms. The intermediate core is formed by the combination of two hollow dowel cores into which a conventional metal ceramic bridge is incorporated. Aesthetically speaking, the prosthetic construction is characterized by the absence of metal visibility. The use of the pterygoid bone radically transforms prosthetic indications. It is advisable that the extremity of the implant remains accessible. Linking to the restoration can be carried out with a screwed telescopic substructure. It is not necessary, at the level of the pterygoid bone situated outside the limits of the arch, to carry out any dental morphology. A smooth, polished construction situated below the plane of occlusion is sufficient.