implants - international magazine of oral implantology

industry report _ CAD/CAM bar restoration I I 25implants3_2011 implants3_2011 Fig. 5_The bite template is fixed in the mouth on two implants. Fig. 6_Preparation for pick-up impression: The four separate parts of the bar are screwed-in in the mouth. Fig. 7_The segments are splinted with a small amount of autopolymerisate. The Friadent MP abutments are not removed afterwards. Fig. 8_Double-mix impression. Fig. 9_The master cast with removable gingiva mask. Fig. 10_The wax-up. structed eating and speaking. There were no general medicalfindingsrulingoutanimplantation.Afterde- tailedconsultation,weoptedforabardentureonfour implants placed inter-foraminally in the mandible. A fixed restoration was not possible owing to cost con- siderations. A prosthesis on two implants, which would be more economical, was not an alternative fromamedicalperspective.Thepatientdesiredassta- ble a restoration as possible and we had to avoid degradation of the implant site through tilting mo- tions in each case. In the current case, the precision, which can only be achieved with this procedure, turned the balance in favour of a CAD/CAM-produced bar construction. This is also the reason that our dental laboratory, whenever possible, uses wide-span superstructures that are fabricated industrially. The result becomes ultra-predictable in conjunction with the two-stage impression process that we have been implementing with a conventionally cast framework for years. We frequentlyusethetwo-stagemethodwheneverthere are high demands on accuracy of the impression. _Transfer of implant positions Four months after insertion, the osseointegrated implants (XiVE S, length: 13 mm; diameter: distal 4.5mm, mesial 3.8 mm) were restored with gingiva formers. The situation was impressed and an indi- vidual tray created. The impression at implant level was made two weeks after uncovering (Fig. 2). The DENTSPLY Friadent pick-up transfer copings were thenscrewedontotheanaloguesinthedentallabo- ratory. Precisely transferring the oral situation with theabutmentsontothemodelrequiresasecondim- pressionwithanappropriatecontrolkey.Abarmade fromautopolymerisatewasusedforthis.Inorderto reconcile any tensions, which develop during poly- merisation, the bar is divided into four parts (Fig. 3). We went on to make a second individual tray (Fig. 4) and a plastic-based template to determine the rela- tion. We designed the template in such a way that it can be secured with two impression copings onto the Friadent MP abutments (DENTSPLY Friadent) fixedinthemouth(Fig.5).Thisistheonlywaytotest the bite reliably, as well as the aesthetics, function Fig. 6Fig. 5 Fig. 8Fig. 7 Fig. 9 Fig. 10