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CAD/CAM - international magazine of digital dentistry

30 I I case report _ guided surgery a collagen matrix. Suture closure in the area of the anterior implant resulted in complete coverage of the augmentation area. The closure screw lay only minimally exposed approximately 3 mm below the mucogingivaltissue.Soft-tissueclosureattheNNC closure screw supported transgingival healing of the implant (Fig. 6). Intra-operative haptic assess- ment of the various fixations of the implant in- sertion aids was easily possible (Fig. 7). In order to assess post-operative treatment success with re- gard to adequate peri-implant bone coverage in particular, a control CBCT scan was taken to verify the correct implant–bone relation. This meant ad- ditional augmentation measures could be safely dispensed with (Fig. 8). Perioperative medication included antibiotic endocarditis prophylaxis. The patient was also given post-operative pain medi- cation for one day. Prostheticrestoration Following integration of a provisional denture and a complication-free healing period, individu- alisedgingivalarchitecturewasthencreatedinthe anterior region. In order to facilitate continued wearing of the provisional denture during the gradual process of soft-tissue conditioning, our dental laboratory prepared and shortened a Regu- lar CrossFit Connection temporary abutment with hard polymer plastic, individualised to the area of the soft-tissue profile (Figs. 9–11). The impression for the incisor abutment was taken with a gingiva former in place on the basis of a Regular CrossFit Connection impression post to match the indi- vidual impression post. The NNC implants were incorporated into the impression (Fig. 12) with the ready-made NNC impression posts. On account of the patient’s allergy and in consideration of the aesthetic aspect, in addition to titanium abut- ments (Fig. 13) it was decided to use a zirconia- based bridge framework with ceramic veneering (Figs. 14 & 15). The titanium abutments and zir- conia bridge were designed virtually using the Straumann CARES Scan CS2 scanner in our own dental laboratory and the framework was made at the Straumann Milling Center in Leipzig. Because of the inter-occlusal distance, an ana- tomicallyformedzirconiaocclusalsurfacewasused, which was optimally prepared with the Straumann CARES System processing software during the constructionphase.Inconsiderationoftheaesthetic aspect, the individualised veneering was mostly in the vestibular region (Figs. 16 & 17). A post- operative radiographic control confirmed correct positioning of the prosthetic components (Fig. 18). _Conclusion Thepatientwasextremelysatisfiedwithboththe result and the cost–benefit relationship. Appropri- ate design of the emergence profile, the titanium abutment and the zirconia bridge entirely fulfilled the aesthetic requirements in the visible areas. In the event of later loss of the second molars, the patient wishes to undertake prosthetic restoration of the ensuing end gap situation. As shown here, in cases of compromised bone and in consideration of the aesthetic zone and CAD/CAM elements of different materials, the use of NNC implants can lead to very positive results._ TheprostheticrestorationwasmadebyDavidSzymanska, MDT(laboratory). CAD/CAM 3_2013 Dr Steffen A.Wolf attained his Doctor of Dentistry degree in 2000 from the Department of Oral and Maxillofacial Surgery at the Freie Universität Berlin headed by Prof.B.Hoffmeister. Since 2000,he has worked in his own private practice in Halberstadt in Germany. He received a Master of Science degree in Oral Implantology in 2010 from the DGI. CAD/CAM_about the author Fig. 16 Fig. 17 Fig. 18