1. REHABILITATION USING A VARIO SR COMPONENT ON A TILTED
IMPLANT.
Dr Henning Bastian
Slotsgade 18, 2.
5000 Odense
Denmark
Contact address: hlb@os.dk
SUMMARY
This case shows the use of a tilted implant to avoid sinus
involvement and a region with only a small amount of
bone. This case was restored quite simply using a Camlog
Vario SR component.
Dr Bastian graduated as a dentist in 1971 from the dental school
at Århus University, Denmark and specialized in Oral and
Maxillo-Facial Surgery in 1986 from Odense University Hospital.
Dr Bastian was Head of the Department of Oral and Maxillofacial Surgery at Odense University
Hospital 1988-2010. He was Ass. Professor in Oral Medicine and Oral Pathology at Odense and
Århus University. Since 1977 he has been Forensic Odontologist at the Department for Forensic
Medicine, Odense University. He is Editor in Chief of the Danish internet site
www.tandogmund.dk-2000. Since 2009 he has been a Member of the Camlog Expert Panel and since
2010 in private pratice in Oral and Maxillofacial Surgery in Odense, Denmark.

2. INTRODUCTION
A 48 year old man avoided recommended treatment for a decade. When he returned
the situation had become quite bizarre with “implants” placed overseas to maintain
an existing failed bridge. It was necessary to completely re-formulate the treatment
plan.
CURRENT SITUATION
There was pain in the region about the bridge. A foul odor emitted from the area
and the bridge was tender to percussion. A radiograph showed that the distal
tooth was completely periodontally involved and that the bridge was separated
from the anterior abutment, which had . All that was maintaining the bridge in
position were two screws placed through the bridge.
The patient’s general health was good. He was not taking any medications and he
had no history of allergies.
TREATMENT PLAN
It was necessary to remove the bridge, and the teeth which had been supporting
it. After a period of healing, implants would be placed to support a new
rehabilitation.

3. Fig. 1
A 48 year old man had pain and bad odor from around an old bridge, due to advanced periodontal
breakdown. The treatment plan was to remove the molar but the patient did not return for therapy.

4. Fig. 2
Ten years later, he returned in severe pain. An x-ray showed the bridge had separated from the
premolar abutment and that screws (implants?) had been placed in the bone and into the sinus.

5. Fig. 3
The treatment plan was changed. The bridge with all three teeth needed to be removed. The patient
was then referred to me for implant treatment.

6. Fig. 4
The situation after the removal of the bridge. Notice the missing bone in the first molar region. The
plan is to place three implants with the most distal being tilted mesially.

7. Fig. 5.
The three implants avoided the problem with the missing bone and any need for sinus augmentation.
3.8 x 11mm Camlog Screwline PromotePlus implants were placed (9mm for the second premolar).

8. Fig. 6
Two months later, the implants are tested clinically with torque and percussion tests. All show
good osseointegration. We are now ready to take an implant-level impression for the final bridge.

9. Fig. 7
At the start of the prosthetic treatment. Notice the fine gingival response around the gingivaformers.

10. Fig. 8
3.8 mm Camlog Open-Tray impression posts are used for the impression.

11. Fig. 9
The tray is perforated to allow access to the impression posts to retract the stabilization screws.

12. Fig. 10
The impression prior to having implant analogs attached. The distal molar will be restored with a
a Camlog 200 Vario SR abutment.

13. Fig. 11
The final bridge secured in place with the access screwholes filled by resin composite. The final
result fullfills the functional and cosmetic requirements very well.

14. Fig. 12
A composite radiograph of the final bridge in place. Notice the healthy bone line about the implants.

15. DISCUSSION
This case could have been treated in several different ways. The patient wanted
three teeth. The treatment options were as listed below:
#1. Open sinus lift 16 and two implants 16,14 with a 3-unit bridge.
#2. Two implants 15,14 with a two-unit bridge with a distal extension.
#3. Open sinus lift and three implants 16,15,14 with a three-unit splint.
$4. Three implants 17 (tilted) ,15,14 with a four-unit bridge.
These four treatment options needed to be compared taking into account
treatment time, morbidity, costs, bone quality, and long time survival rate for the
implants.
The patient wanted to avoid an open sinus lift because of the extended treatment
time and the risk of postoperative morbidity.
So the choice came down to being between options #2 and #4.
As a professional, I recommended the patient to have option #4 with respect to
the optimal loading conditions and the well-known problems with a distal
extension.

16. CONCLUSION
Dentists should be aware that tilted implants can be very useful in the right
situation. In this case, the use of a tilted implant allowed the patient to avoid an
open sinus lift procedure and to reduce the treatment time by six months.
By use of VarioSR system components the angulation of the implant could easily
be overcome and the restorative process was made very simple.
Overall, the treatment was turned from “complex” to “straightforward” in a very
elegant way.

17. Tak