implants - international magazine of oral implantology

case report I expensive, dentists should seek suitable partners to support them in the integration of current therapy options. Furthermore,fromabiologicalandaneconomic perspective,productionshouldrelyonthemostbi- ologically compatible material with sufficient me- chanicalstability,forexampletitaniumandcobalt- chromiumalloys.Zirconiumoxideisalsoanoption. However, in terms of casting engineering, the pro- cessing of these alternative materials does not of- fer sufficient precision of fit. Cast implant struc- tures manufactured from non-precious metals have been found to exhibit gaps with an average widthof200to230µmbetweenthesuperstructure and the implant abutment.2 In contrast, cast struc- tures manufactured from precious metal alloys have been found to have gaps with an average width of 40 to 50 µm.3 The use of alternative mate- rialsthusrequirestheuseofalternativeproduction technologies, if only to obtain the required preci- sion. Ideally, a superstructure is milled from an indus- trially prefabricated solid material in order to elimi- nate inhomogeneities safely. Following this line of thought, milling-based manufacture of superstruc- turesusingtheCNC(computernu- merical control) procedure began more than ten years ago. Attempts withthiskindofCAD/CAMtechnology demonstrated that the achievable preci- sion of current constructions—between 20 and 30 µm—is better than the precision of fit achieved with cast precious metal structures.3 Withmodernscanningandsoftwaretechnology, this production principle has been extended to the area of virtual construction. Thus, the CNC milling procedure, which has been used for years, is supple- mented with the possibility of a purely virtual con- struction. This technology is now offered by various manufacturers. _Objective Our objective as specialists must not only be the replacement of a lost tooth as soon as possible after extraction, but also be the satisfaction of our pa- tients’ constantly increasing aesthetic demands— withregardtotheanteriortoothareainparticular— throughsuitableboneandsoft-tissuemanagement. Thus, even when the implant is being inserted, preferencemustbegiventokeepingthecrestalbone structure as unchanged as possible because in this waytheinterdentalpapillaandtheperi-implantgin- giva can be maintained in the long term.4 _Case presentation The realisation of the patient’s wish was facili- tated in the following case in close collaboration Fig. 4_Condition immediately after the healing abutments were placed (height of 2 mm). Fig. 5_Three weeks of good healing and moulding of the peri-implant soft tissue. Fig. 6_Schematic depiction of the Conical Seal Design for a custom-fitted conical connection between the implant and abutment. Fig. 7_Abutments on the master cast with the gingival mask. Fig. 8_Virtual 3-D model for abutment planning below the subsequent crowns. Fig. 9_Virtual 3-D model for patient-specific abutment planning. Fig. 10_Occlusal view of the abutment and adjustment thereof. I 29implants4_2012 Fig. 4 Fig. 5 Fig. 6 Fig. 8 Fig. 9 Fig. 10 Fig. 7