implants - international magazine of oral implantology

I industry report abutments with a 3 mm post. All of the abutment postshavediametersoremergenceprofilesof3.5,4.0, 5.0or6.5mm,suitableforallowinganaturalanatom- icalshapeofthesofttissues.Abutmentdiametersare therefore independent of implant diameters, which means that any implant may host the four different abutment emergence profiles. The different emer- gence profiles start from the 2 mm , 2.5 mm or 3 mm posts,placedatcrestalbonelevel.Thegeometryofthe abutments provides for platform switching even at a prosthetic level, which is of vital importance in the or- ganization of the connecting tissue and the epithelial layer. Thesupraperiostealspaceinvolvedintheshiftfrom the connecting post diameter (2–3 mm) to the diame- ter of the abutment hemisphere (3–6.5 mm), allows a thickeranddenserconnectingtissuetoform,resulting in the optimal preservation of the papilla. In the fol- lowing case, all the selected abutments have a 3 mm post,astheymustconnecttothe3mmwellsofthe5.0 x6.0mmimplants.Abutmentpostheights,inclinations and diameters are selected in the laboratory in accor- dance with the position of the implants relative to the anatomyofthealveolarridge. Trinia is a CAD/CAM multidirectional fiber rein- forcedresinmaterial,whichdespiteitsleightweightis capableofwithstandingocclusalforces. _Case report A 52-year-old male patient, presenting a severely compromised mandibular bone, was treated with the placement of four short implants. Two SHORT® im- plants(4.5x8mm)wereplacedbilaterallyatthecanine region and two ULTRA SHORT® implants (4 x 5mm) werebilaterallylocatedatthefirstmolarregion(Fig.1). The implants were placed in a two-stage surgery and they were uncovered after a healing period of three months(Figs.2and3). Clinically, the prosthetic treatment began with an implantleveltransferimpressionbyinsertingwithonly fingerpressurea greenimpressionpostwithitscorre- sponding acrylic sleeve into the 3.0 mm implant well, prior to recording their position by making an implant level impression with any conventional impression material (Fig 4). Upon the removal of the full arch im- pression, green impression posts were removed from the implant wells and inserted into an implant analog ofthesamecolorbeforeinsertingthemintotheircor- respondingacrylicsleeveswithintheimpression. Prior to the pouring of a stone model, a resilient acrylicwasappliedaroundtheimpressionpoststosim- ulateasofttissuecontourinthestonemodel.Thestone modelwas used for the fabrication of a wax bite rim to record the occlusal registrations. After articulation of the models, appropriate abutments with the largest practical hemispherical base were selected and in- sertedintotheircorrespondingimplantanalogswithin the stone model. Their prosthetic posts were then milledparalleltooneanother(Fig.5). The model with the milled abutments was used to fabricate a light cured resin bar and denture tooth set upforanintra-oralconfirmationofthearrangedteeth. Once the denture set-up had been clinically approved, afacialocclusalsiliconemaskwasinitiallyformedover thedenturewaxsetup.Priortoformingthelingualsil- iconemask,indexingoralignmentgrooveswereplaced inthefacialocclusalmask.Afterfabricationofthelin- gual mask, grooves were cut into the stone model to preventthesubsequententrapmentofair,whenacrylic waspouredintothesiliconeflaskthroughanteriorcut- away or aperture in the lingual mask. Prior to the re- moval of the wax denture tooth set up from the stone model, the facial lingual extent of the wax denture tooth set up on the alveolar ridge was marked on the stonemodelwithapencil. Aftertheremovalofthedentureteethandwaxfrom the resin bar, the teeth were cleaned and lingually roughened or modified prior to being facially glued to the facial occlusal silicone mask with cyanoacrylate glue.Anuneventhinapplicationofclearresinwasthen appliedtothecervicalareaoftheteethonthemaskto achieveanaestheticstratificationofthegingivalden- ture resin. The facial occlusal mask and the resin bar werethenrepositionedonthemodeltoconfirmtheap- propriateness of their contours relative to each other 30 I implants3_2012 Fig. 12 Fig. 13Fig. 11