CAD/CAM - international magazine of digital dentistry

40 I I case report _ implant therapy Once this has been milled, it will lock tightly in- to the thermoplastic drilling template. At this point, the surgical guide is complete and can be used on the patient. In this particular case, an OsseoSpeed TX im- plant (DENTSPLY Implants) (4.0 × 11 mm) was placed using the surgical guide. The patient was prepared in accordance with a standard sterile protocol and the area anaesthetised as one would for a regular implant placement. The sur- gical guide snaps firmly over the existing teeth, expandingover-andundercuts,becomingavery stable platform through which to drill. The Fa- cilitate soft-tissue punch was used to remove the overlying soft tissue, and a standard drilling protocolusingtheSironadrillkeyswasfollowed. A high primary stability of 40 Ncm was ob- tained and a 4 mm healing abutment was placed immediately. The patient healed with no pain, no swelling and no discomfort. The post-operative long-cone periapical radiograph corresponded wellwiththepreoperativeplanningwithanideal angulation for a screw-retained crown. After two months of healing, a fixture-level open-tray impression was taken and cast up using an Astra Tech replica. A standard metal abutment was inserted into the replica and cut back by 3 mm from the occlusal table. This was then powdered and scanned using the CEREC Bluecam, and an IPS e.max CAD C 14 block was milled. The CEREC 4.2 software was instructed to mill a hole that corresponded to the screw-insertion path on the abutment. This was finished using a high-speeddiamondburwithcopiousirrigation. The crown was glazed and sintered, allowed to cool and bonded to the abutment using Variolink II (Ivoclar Vivadent). The final crown was screwed directly onto the implant and a final check for contacts and occlusion was done. This process shows just how far CAD/CAM technology has come. An implant can be planned, inserted and restored all in-house, using the current available technology. The final result is equal to any laboratory-based restoration, albeit for simple units. The process does have its limits in terms of multiple-span bridges and placement of multiple implants, especially in edentulous areas. As the technology develops, with further advances being made, the scope of what is possible for the implant dentist is always expanding._ Fig. 15_CEREC image of the abutment. Fig. 16_CEREC image of final restoration. Fig. 17_CEREC image of the block. Fig. 18_E-max crown glaxed, stained and ready for sintering. Fig. 19_Milled E-max CAD/CAM crown with screw hole. Fig. 20_Screw retained E-max crown. Figs. 21 & 22_Final restoration in-situ. CAD/CAM 1_2013 Dr Nilesh R.Parmar,BDS (Lond.),M.Sc.(Prosth.Dent.), MSc (Imp.Dent.),Cert.Ortho., was voted BestYoung Dentist in the East of England in 2009 and runner-up in 2010. He was short-listed for the Private DentistryAwards in 2011 in the category of Outstanding Individual. He has a master’s degree in Prosthetic Dentistry from the Eastman Dental Institute and a master’s degree in Clinical Implantology from King’s College London.He is one of the few dentists in the UK to hold a degree from all three London dental schools and recently obtained his Certificate in Orthodontics from the University ofWarwick.His main area of interest is dental implants and CEREC CAD/CAM technology. Nilesh runs a successful five-surgery practice close to London and is a visiting implant dentist at two Central London practices.Nilesh has a never-ending passion for his work and is well known for his attention to detail and his belief that every patient he sees should become a patient for life.He offers training and mentoring to dentists starting out in implant dentistry.More information can be found on his website,www.drnileshparmar.com;Twitter: @NileshRParmar; or Facebook:Dr Nilesh R.Parmar. CAD/CAM_about the author Fig. 21Fig. 20 Fig. 22