CAD/CAM international magazine of digital dentistry

I 19 case report _ implant prosthetic restoration I CAD/CAM 4_2012 mechanically inserted at a slow rotational speed (Fig. 9). In the process, the XiVE implant thread grips the bone palatally, while the labial lamella is not traumatised. The implant was sealed against saliva and bacteria using a colour-coded cover screw in preparation for the submerged healing phase. The gaps in the implant site were then filled using the autogenous bone chips collected during the drilling process. In order to compensate for the resorption of the autogenous bone, a stable- volume alloplastic bone-grafting material was placed over the bone chips as a second layer. The raspatory was placed in front of the na- sopalatine nerve to protect it, as there is only a thin bone lamella between the nerve and the mucosa. A resorbable collagen membrane was then placed over the augmented area and fixed to the bone with two titanium nails (FRIOS mem- brane tacks, DENTSPLY Implants). In this way, the mucoperiosteal flap prevented shifting of the membrane. A double-layered wound closure was per- formed in order to prevent dehiscence. First, a resorbable suture (4.0) was used to attach the periosteum to the periosteum (Fig. 11). Then the mucosa was passively fixed with two over-and- over sutures. The radiological control shows that the XiVE implant in region #21 was positioned nearer to tooth #22 than to tooth #11 (Fig. 12). This distal position is typically due to the location of the nasopalatine nerve and is unavoidable. Uncoveringandsoft-tissuemanagement Three months post-implant placement, the vestibular gingiva showed no signs of inflamma- tion(Fig.13).Measurestoimprovethesoft-tissue volume by extension in the aesthetic zone were planned.TheXiVEimplantwasuncovered(Fig.14) and the cover screw was replaced by a Friadent gingiva former for this purpose (Fig. 15). Fabricationofthetemporaryrestorationusing CAD/CAMtechnologyinthedentallaboratory After a brief healing phase of ten days, the patient was recalled for the actual temporary restoration. A suitable impression coping for transfer technique with a TransferCap was in- serted into the implant for impression taking using a polyether material (Fig. 16). The cast model of the maxilla subsequently fabricated in plaster was then scanned in. An individual abutment was virtually created with the aid of the ScanBase, which displays the scan- able counterpart to the TitaniumBase (DENTSPLY Implants;Fig.17).Theresultingconstructiondata was transmitted to the milling machine, where the abutment was milled from a lithium disili- cate block (Fig. 18). The finished abutment was then cemented to the TitaniumBase. After com- pletion, the precise position for the intra-oral insertion was reproduced on the master cast using a transfer key made from Pattern Resin Fig. 13_Three months post-implant placement, the gingiva showed no signs of inflammation. Fig. 14_The XiVE implant was uncovered. Fig. 15_To improve the soft-tissue volume in the aesthetic zone, the cover screw was replaced by a Friadent gingiva former. Fig. 16_Friadent transfer post with a suitable TransferCap in situ prior to impression taking. Fig. 17_Virtually created individual abutment. Fig. 18_The abutment was milled from a lithium disilicate block on the basis of the construction data. Fig. 16Fig. 15 Fig. 14Fig. 13 Fig. 18Fig. 17