CAD/CAM - international magazine of digital dentistry - wydanie polskie

39391_2014 CAD/CAM case report _ CAD/CAM in implantology I 19 case report _ CAD/CAM in implantology I CAD/CAM 2_2012 have forced us to add grafting material. The patient did not consent to such a solution and expected a predictable cosmetic effect with the stress on very good final aesthetics. In the first stage, we made a Maryland bridge (Fig. 2). Such a solution provided protection for the patient during the osseointegration period. Several months after the surgical procedure, the implant (in this case Ankylos, DENTSPLY Friadent) was ex- posed.Itturnedoutthattheimplantwaspositioned in an excessively palatal direction. The challenge was to restore a symmetrical line to the patient’s cervical margins, as well as a natural biological gingival margin. The backward position of the im- plantrequiredtheuseofanangledabutmentof30°. Unfortunately, the system we used effectively re- strictedsuchanapproach,sinceatthetimethatthe above procedure was performed it was still impos- sibletoachievecustomisationinadentallaboratory (this is definitely possible today). A decision to make an all-zirconia abutment with an angle of inclination above 15° is quite risky. Hence, the solution we adopted was to modify the crown while not changing the shape of the abut- ment. Such an approach requires the attending dentisttoplayamajorroleintheprocesssothatthe preparation and transfer of the emergence profile of the abutment and prosthetic crown correspond perfectlytothenaturaltooth.Usingcompositema- terial, the doctor shapes the temporary restoration toretaintheplaceforthefinalcrownforaperiodof severalweekssothatitlatercanserveasamodelfor the definitive crown. It is important to remember thatasthegingivaisbeingshapedthepatientmust at all times be provided with a temporary restora- tion, guaranteeing support for the soft tissue. Therefore,thedoctortransferredtheemergence profilewiththehelpofadoublingofthecrownwith the abutment. After the crown had been removed, pattern resin was applied in its place. Simultane- ously,astandardzirconiaabutmentwasmodifiedin the dental laboratory into the desired shape using a water-cooled high-speed bur and then scanned. An image of the scan was modified by superimpos- ing a second scan over the projected emergence profileofthecrown.Bothpartswerejoinedtogether in the CAD programme and the structure thereby created was cut from the Provi Disc composite ma- terial(Robocam),whichisoftenusedfortemporary restorations. At this stage, the best approach is to try in the cut-out substructure and if necessary im- Fig. 16_Abutment and coping prior to firing and bonding. Fig. 17_Palatal view of veneered crown bonded to the abutment. Fig. 18_Visible emergence area, free of ceramic. Figs. 19a, b & c_Finished crown in situ. Fig. 20_Palatal view of screw-retained crown. Fig. 21_Crown in full smile. Fig. 19a Fig. 19c Fig. 16 Fig. 18 Fig. 20 Fig. 21 Fig. 17 Fig. 19b