CAD/CAM - international magazine of digital dentistry

22 I I case report _ dental implantology area.Nowattentionisbeingfocusedontheimplant abutment. In addition to standardized abutments, components customized to the patient are be- coming increasingly important and promise highly aesthetic results and long-term stability. State-of- the-artrestorationsalsofocusonotherfactorssuch as a minimally invasive procedure and a prognosis- oriented approach, for instance the prevention of peri-implantitis. Before the abutment is fabricated, implant placement or planning of the optimal im- plant position must be taken into account. The emergence of the implant platform or collar from the soft tissue must be taken into consideration at this stage, and the abutment must be designed accordingly. Three-dimensional diagnostics pro- vide the ideal basis for the conceptual planning. The optimum result can be visualized in advance and the treatment sequence precisely defined. _Initial situation and planning The patient approached the treatment team with a wish for an implant-supported prosthetic restora- tion in region 36. The patient’s general medical history revealed no anomalies. The oral situation alsoindicatednosignificantneedfortreatment.The maxilla was fully dentulous, but a radicular cyst on tooth 12 was diagnosed radiographically. Surgical treatmentofthiscystisscheduledinthenearfuture. A similar picture emerged in the mandible. After closing the gap in region 36 and restoring tooth 12, the treatment will be completed. The initial radio- graph (OPG) showed sufficient vertical bone (Fig. 1), but a lack of buccal bone volume from a clinical per- spective. This was confirmed in the three-dimension- alview(DVT).Theimplant(XiVE,DENTSPLYImplants) inregion36wasplannedvirtuallyinaslightlylingual position using a planning and navigation software and the need for augmentation in the buccal area wasevaluated(Figs.2a–c).Theconcaveprofileofthe alveolar ridge would not allow for an aesthetically satisfactory result without grafting. The goal was to achieve a buccal plate of approximately 2 mm, and thusaslightlyconvexridgeinthisarea.Thisrequired systematic treatment planning. All natural struc- tures of hard and soft tissue should be optimally Figs. 7a–c_Delivery of abutment, transfer guide and a temporary crown. Fig. 8_After the healing phase, the conditions were stable and the width of the alveolar ridge was sufficient. Fig. 9_Careful exposure of the implant. The laser ensured a minimally invasive procedure. CAD/CAM 2_2014 Fig. 9Fig. 8 Fig. 7c Fig. 7bFig. 7a CAD0214_20-24_Bergmann 13.05.14 11:16 Seite 3