CAD/CAM - international magazine of digital dentistry

I 19 case report _ use of CAD/CAM abutments I CAD/CAM 1_2014 mentsfollowedsince2008havefoundthathealthy tissue that is absent of inflammation quickly forms as the tissue adapts to the abutment’s base shape. Additionally, over that same two- to three-year pe- riod of clinical observation, during which multiple casesofabutment-controlledperi-implantsulcular stretchingweremonitored,nosignificantrecession around these abutments was noted. Several important clinical prerequisites should bemetwhensulcularstretchingoftheperi-implant tissue using fully anatomical patient-specific abut- ments is attempted, including the following: _Anyrequiredtissuegrafting,bonegraftingorridge distractionshouldbeperformedandtheareafully healed. _The top of the implant should be located at least 2.5 mm below the soft-tissue crest, and in the middle or lingual third of the ridge crest. _The edentulous ridge should be well-formed with acrestalheightcomparabletothegingivalmargin heights of the neighbouring teeth. _The peri-implant sulcus should be significantly smaller than the tooth to be replaced. _Case presentation The patient presented with a fractured maxillary left lateral incisor in need of extraction (Figs. 1–3). After several months of healing, an impression was taken (Figs. 4 & 5), and sent to the laboratory with a prescription for the fabrication of an ATLANTIS patient-specific abutment in zirconia (DENTSPLY Implants; Fig. 6). The abutment was anatomically designed based on the desired final tooth shape to optimise both function and aesthetics (Fig. 7). In order to seat an anatomical patient-specific abutment properly, the cover screw is retrieved and any loose granulation tissue found within the sulcus is curetted away (Fig. 8). The peri-implant sulcus is anesthetisedcircumferentiallytominimisethepatient discomfort resulting from the pressure the oversized abutment will apply to the soft tissue when it is screwed into place. If epinephrine is used, the peri- implanttissuewilllikelyblanchfromvasoconstriction. Fig. 4_Six months after hard- and soft-tissuegraftprocedures,thepatient returned for the final impression. Fig. 5_A radiograph taken to verify proper seating of the transfer impression coping. Fig. 6_The impression and case materials were sent to the dental laboratory with a request for an ATLANTIS zirconia abutment. Fig. 7_Fabrication of the final crown. Fig. 8_The patient returned for place- ment of the final abutment and crown. Fig. 9_The fully anatomical abutment was seated to manage and shape the soft tissue. Initial blanching of the surrounding tissue was observed. Fig. 10 Fig. 8 Fig. 11 Fig. 12 Fig. 7 Fig. 9 CAD0114_18-20_Kerstein 14.04.14 11:45 Seite 2