CAD/CAM - international magazine of digital dentistry

I 27 case report _ customised implant abutments I CAD/CAM 2_2013 in the patient being entirely opposed to another intervention of this kind on the opposite side of the mouth. During an appointment in October 2011, I was able to persuade the patient to accept implant treatment. I suggested first removing the three- unitbridgeonteeth23–25andthenextractingthe roots of teeth 23 and 25, as well as seating of a denture on the day of the extraction, followed by placement of three implants in regions 23–25, the extraction of tooth 26, and seating of a four-unit bridge as the final prosthetic solution. Astheheightoftheavailablebonearoundtooth 26wasinsufficient,Iwouldnotplaceanimplantin that area but a tooth extension (a sinus lift would otherwisehavebeenessential).Thetreatmentplan was accepted by the patient two weeks later, and teeth 23 and 25 were extracted at the end of the month. Thepatientwasseenon10January2012forim- plant placement: two implants (NobelReplace RP, Nobel Biocare) with a diameter of 4.3 mm and a length of 13 mm for regions 23 and 24, and one implant (NobelReplace WP) with a diameter of 5mmandalengthof10mmforregion25.Tooth26 was extracted on the same day without placement of an implant as already mentioned. In May 2012, implant-level impressions were taken (open-tray impression technique), and the patient’s occlusion was recorded using silicone and a bite tray. Owing to the constraints related to the angulation of the implants in regions 24 and 25,Ioptedfortitaniumabutments.Theangleofthe implant in region 23 allowed for the insertion of a titanium–zirconia abutment for good gingival grip and a better aesthetic result. Ten days later, two titanium abutments (ANA. T, Laboratoire Dentaire Crown Ceram) and one ti- tanium–zirconia abutment (ANA. TZ, Laboratoire Dentaire Crown Ceram) were screwed onto the implants at a torque of 35 N, and sealed with Figs. 2 & 3_CAD/CAM at the laboratory for design of the abutments. Fig. 4_CAD/CAM at the laboratory showing the framework according to the abutments. Fig. 5_ X-ray control of the abutments placed. Fig. 6_Panoramic X-ray view and 3-D simulation of the implants. Fig. 3 Fig. 4 Fig. 2 Fig. 6Fig. 5