CAD/CAM - international magazine of digital dentistry

20 I I case report _ use of CAD/CAM abutments The abutment is then set into the implant, aligned properly, held down firmly into place, and the abutment screw is then torqued according to the manufacturer’s guidelines. During the screw- ing-in process, the anatomical abutment will compress and blanch the surrounding soft tissue (Figs. 9 & 10). Proper seating should be radi- ographically verified to ensure no soft tissue is trapped underneath the abutment that would keep the abutment from sealing fully with the top of the implant. When using ATLANTIS patient-specific abut- ments, a final crown can often be placed during the same appointment in which the abutment is inserted. The final crown can be fabricated before the patient appointment by ordering an identical duplicate abutment made from the same digital abutment file used in designing the intra-oral abutment.7, 8 The duplicate is an exact master die upon which the final crown can be constructed. It is our clinical observation that at routine follow-up of these stretched-sulcus anatomical abutment cases, a consistent healthy soft-tissue response is visible, with stable maintenance of the hard- and soft-tissue contours over time (Figs. 11 & 12). _Conclusion The utilisation of ATLANTIS patient-specific CAD/CAM abutments can help eliminate the need for prefabricated soft-tissue healing abutments, while providing natural anatomical and optimal aesthetic implant-supported restorative results. Patient-specific abutments with a specific sub- shoulder design and an emergence profile cus- tomised to the particular implant placement and site can be utilised to stretch a small, round peri- implant sulcus outwards and induce it to adopt the shape of the abutment, such that both the tissue and final crown contours appear natural. With this technique, blanching of the soft tissue at the time of abutment placement is common buthasminimalimpactonthelong-termmarginal hard-andsoft-tissuehealth,especiallywhenused in combination with an internal conical connec- tion implant. Lastly, the use of patient-specific abutments both for soft-tissue sculpting and as the perma- nent abutment solution has significant clinical advantages over the traditional approach, in- cluding simplifying tissue contouring around dental implants for the restorative clinician, and reducing the number of procedures and proce- dural discomfort, and faster healing time for the patient._ Editorial note: A complete list of references is available fromthepublisher. Fig. 10_Approximately 30 minutes after the final restoration was in place, the blanching was already significantly reduced. Fig. 11_A radiograph of the abutment. Fig. 12_The lingual view after placement of the final abutment and crown. Fig. 13_Seven months post-implant placement and two weeks after placement of the final abutment and crown, a continued healthy tissue response could be seen. Fig. 14_The follow-up at two and a half years showed maintained healthy soft tissue. CAD/CAM 1_2014 Julian Osorio,DMD Osorio Dental Group 60 Federal Street Boston,Massachusetts 02210 USA www.watkinosorio.com Robert B.Kerstein,DMD Back Bay Dental Care 21 Bay State Rd,Suite 3, Boston,Massachusetts 02215 USA CAD/CAM_contact Fig. 13 Fig. 14 CAD0114_18-20_Kerstein 14.04.14 11:45 Seite 3