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implants - international magazine of oral implantology

industry report I I 33implants3_2012 unit caused by abrasion. Furthermore, the interlock- ing gives the patient the important feeling of confi- dence,sinceunwantedlooseningoftherestorationis precluded. _Materials Individually milled bars are usually cast in a chrome-cobalt or gold alloy. A recent option is the centralCAD/CAMfabricationofvirtuallydesignedbar constructionsinaccordancetoamodelscan.Thisfab- ricationvarianthasnumerousadvantages:ontheone hand,thetension-freefitofthebarontheimplantsis not affected by the shrinkage of the metal caused by cooling. On the other hand, it is possible to manufac- ture the bar from titanium, which may result in a re- ductioningingivalinflammation(AbdEl-Dayemetal., 2009),sincethereisabetterattachmentofthetissues here.TheteamunderAbdEl-Dayemfurtherconcludes that both advantages together, the absolutely ten- sion-free fit of the bar and the material itself, could leadtoevenlessperi-implantboneresorption,which further improves the long-term prognosis. _Case presentation A 73-year-old woman, a non-smoker with an un- remarkable medical history, was given six implants with two milled bars as anchoring elements. Five XiVE S plus implants were inserted during a simulta- neous sinus floor elevation and were allowed to heal submerged over six months. When the implant was uncovered, a vestibular graft was performed with an apical transposition flap. Due to the less favorable bone volume in region 16, an additional XiVE TG plus implant was inserted subsequently for the purposes oftheprocedureandwasimmediatelyloaded(Fig.1). The impression for the fabrication of the CAD/CAM barswasmadefourweekslaterontheMPabutments inserted during this consultation (Figs. 2 & 3). TheadvantageoftheFriadentMPabutmentsisthe transfer of the working level from the implant shoul- der—that is, the crestal edge of the bone—to a supracrestalplane.Hence,theappositionofthemar- ginal tissues on the abutment components is not af- fected by try-ins and other treatment steps. Further- more, a simple visual check of the bar seating can be made. Figure 2 shows the patient’s condition prior to impression making, with inserted Friadent MP abut- ments. The model fabricated using the MP analogs and a XiVE TG implant analog was sent to the DENTSPLYScanCenterwiththetemporaryconstruc- tion. The option of displaying and masking various structures, such as the soft tissues, the dental arrangement, the implants and the bar construction, allowsasimplifiedcheckoftheconstructionproposal (Figs. 4a–4d). This is adjusted to the practitioner’s preferences as required. Galvanic bar latches are manufactured on the titanium CAD/CAM-fabricated bars,embeddedintheopeningsfortheslideaxles.The tertiary structure is cast from a chrome-cobalt alloy. In order to guarantee a tension-free fit for the sup- ported metal base, this was cemented to the bar Fig. 3_Functional impression with FRIADENT MP impression abutments Figs. 4 a–d _Screenshots of the virtual bar construction with various overlays. Fig. 5_Working model with bars, bar slides, tertiary structure and inserted slides. Fig. 3 Fig. 4a Fig. 4b Fig. 4c Fig. 4d Fig. 5