CAD/CAM - international magazine of digital dentistry

26 I I case report _ customised implant abutments CAD/CAM 2_2013 Fig. 1_Single crown on an anatomical titanium abutment. _The multiplicity and sophistication of the offering in the field of prosthetic elements in implantology allow the practitioner to make a choice appropriate to the clinical particularities of each case. If the practitioner chooses a stan- dardimplantabutment,thedentaltechnicianwill have to make adjustments, which implies con- siderable losses in precision and time. Moreover, with such abutments it is difficult to create an anatomical emergence profile because it cannot be modified and the base of the abutment cannot bechanged.Thisobservationisequallyapplicable to the angulation, which might even be selected by default. AcustomisedabutmentcreatedwithCAD/CAM is the most accurate and simplest solution for an optimal result. The abutment is individually de- signed in order to ensure the homothety of the thickness of the materials and therefore the over- allstrengthoftheprosthesis.Thedentaltechnician has in this case maximum freedom in terms of design in order to create an abutment with the optimumemergenceprofileandangulation.Inthis manner, the abutment is specifically designed and fabricated for each patient. Titanium has been established in dental im- plantology as the reference material owing to its biomechanicalpropertiesanditsbiocompatibility. Today, we are able to benefit from over 40 years ofclinicalandexperimentalexperienceinimplan- tology. Customised abutments can be fabricated from titanium, zirconia or hybrid materials, such as a combination of titanium and zirconia, which in certain clinical circumstances improves the aesthetics of the visible areas while respecting the requirements of biocompatibility and bio- mechanics. _Seating a four-unit bridge on three anatomical implant abutments Clinicalcase A40-year-oldmalepatientpresentedfortreat- ment. He had no particular medical conditions or any contra-indications concerning the placement of implants. In 2009, the patient had undergone a sinuslift(anincreaseofthemaxillarybonevolume and the displacement of the sinus membrane to ensureimplantsuccessbyincreasingtheheightof the available bone) at a hospital prior to the place- mentofimplantstoreplaceteeth15–17.Thepost- operative sequelae (pain, oedemas, etc.) resulted Fig. 1 Fabrication of a customised implant abutment using CAD/CAM:Asolution specific to each clinical case Author_ Dr Thierry Lachkar, France