CAD/CAM - international magazine of digital dentistry

24 I I case report _ dental implantology _Second surgical session The closed healing phase was complication-free and resulted in an osseointegrated implant 36 a few weeks later, as well as a slightly convex profile of the buccalalveolarridgethankstothegraftingmeasures. Thegoalofaugmentationwasachieved:a3mmthick attached gingiva (Fig. 8). In a gentle laser procedure, a small incision was made to expose the implant (Fig. 9). This minimally invasive procedure made it possibletoavoidraisingtheperiosteumofthebuccal mucosa,whichisessentialforpreservingthegrafted bone. The cover screw was removed (Fig. 10) and the abutment inserted. A plastic index key, created in advance in the laboratory, was again used for accu- rate transfer from the cast to the patient’s mouth. With the key attached over the adjacent teeth, the abutment was accurately transferred and screwed ontotheimplantinthemouth(Figs.11a&b).Aslight anemia in the buccal area confirmed the accuracy of the fit. The contour of the abutment emergence profile blended in well with the intra-oral conditions (Fig. 12). The “preparation margin” was at gingival levelasdesired(Fig.13).Afterensuringthattheabut- mentmetthespecificationsexactlyandthatthesur- face will allow epithelial adhesion in the basal area, the temporary crown fabricated in lithium disilicate using CAD/CAM technology was cemented (Fig. 14). The crown will “train” the bone, and over the coming months, shape the soft tissue profile accordingly before the final restoration is inserted. This way, the healingprocessandtrainingoftheperi-implantgin- givawillrunundisturbed(one-abutment-one-time). _Conclusion In just two surgical treatment sessions, the gap in region 36 was treated using an implant-supported prosthetic restoration. The restoration met all ana- tomical, prosthetic, functional and aesthetic require- ments. With the CAD/CAM method of fabricating the custom abutment (ATLANTIS), a restoration was real- ized in an efficient manner that meets the demands ofstate-of-the-artdentistry.Basedonthe“one-abut- ment-one-time” concept, the titanium abutment will not be removed again after insertion in the mouth. Preservation of the bone and training of the peri- implant soft tissue are thereby optimally supported. Since the crown margin was precisely determined during the virtual wax-up based on the emergence profile, the risk of excess cement and any resulting peri-implantitis was significantly reduced. The crown margin was at gingival level, which greatly simplifies removal of any excess cement. The procedure de- scribed allows long-term stable results and is ideal for referring practices that can realize the prosthetic restorationinasafemannerafterimplantplacement._ Editorial note: A complete list of references is available fromthepublisher. Fig. 12_The abutment is screwed on the implant in the exact position and is not removed again. Epithelial soft tissue apposition is not threatened. The screw access is sealed with composite. Fig. 13_The radiographic check: The designed “biological width” allows optimal apposition of the gingiva in the basal area. Fig. 14_Inserted crown made of lithium disilicate. CAD/CAM 2_2014 DrFredBergmann Privatepractice DrBergmann&Partner Heidelbergerstr.5–7 68519Viernheim Germany www.oralchirurgie.com CAD/CAM_contact Fig. 14 Fig. 13Fig. 12 CAD0214_20-24_Bergmann 13.05.14 11:16 Seite 5