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Dental Tribune United Kingdom Edition

July 2014United Kingdom Edition12 CAD/CAM Tribune days. After coDiagnostiX plan- ning (Figs. 9&10), the osteosyn- thesis retaining screws were removed after four months and the implants placed. Tooth 43, which had been destroyed by caries, was removed on the right. Immediate implantation was performed using a Strau- mann Bone Level implant (Ø 4.8 mm, L 12 mm). Straumann Bone Level im- plants (Ø 4.1mm, L 10mm) were inserted in positions 44 and 46 (Fig. 11). On the left, three Straumann Bone Level implants were placed (in position 33, a Straumann Bone Level implant made of Roxolid; Ø 3.3 mm, L 14mm; in positions 34 and 35, Straumann Bone Level im- plants; Ø 4.1mm, L 10mm; Figs. 12–15). All implants had the SLActive surface specification. Temporary immediate restoration All implants were fitted with 0 degree Multi-Base Abutments with a gingiva height of 4mm (Figs. 16&17). A Narrow Cro Fit Connection Multi-Base Abut- ment (Ø 4.5mm) was used for the Narrow CrossFit Connection Roxolid implant. The terminal implants were fitted with Regu- lar CrossFit Connection Multi- Base Abutments (Ø 6.5mm). Im- pression taking was performed with a foil technique tray9 (Fig. 18) with colour-coded impres- sion components (Fig. 19). The laboratory-made tem- porary prosthesis (Fig. 20) was screw retained occlusally via integrated temporary copings (Fig. 21). The screw channel was sealed with a foam pel- let soaked in 0.1 per cent chlo- rhexidine gel and a light-curing composite.10 The temporary res- toration remained in place for six months (Fig. 22). Final restoration The existing metal–ceramic ve- neer crowns in positions 32 to 42 were removed and the teeth prepared again. For impression taking, the impression posts were laboratory customised to correspond with the gingi- val emergence profile created by the Multi-Base Abutments. This was followed by a single- session, two-phase impression using the double-mix technique with a polyether impression material11, 12 (Fig. 23) and cor- responding colour and shade selection. In order to continue support of the ideally shaped soft tissue (Figs. 24 & 25), a decision was made in favour of CAD/CAM customised abutments made of zirconium dioxide. The basal component of the future meso- structures was designed such that the gingiva would be sup- ported optimally and create an ideal transition from the im- plant connection to the bridge contour. After a pronounced temporary break, one no longer needs to expect changes to the gingival margin. Thus, the future crown margin was placed only 0.5 mm sub- and epigingivally.13 The wax model (Fig. 26) on auxiliary parts, which cor- responded to the implant connection, was digitalised using the Straumann CARES Scan CS2 scanner. After data transmission, the fabrica- tion of the individual abut- ments was performed in the Straumann milling centre. In order to ensure the required fit and the stability needed for the molar region, one-piece zirco- nium dioxide abutments (Figs. 27 & 28)14, 15 were fabricated. After a few days, the dental technician received the patient- specific abutment for further processing. In the next step, a zerion veneering framework (Straumann) was designed us- ing CAD/CAM and fabricated after data transmission (Figs. 29&30). The zirconium dioxide abutments were inserted at a torque of 35Ncm (Figs. 31&32). The dental panoramic to- mogram shows the situation 18 months after implantation (Fig. 33). The screw channels were filled with non-irritating PEMA16 in a trough-shaped final design. Then the final restorations were inserted (Fig. 34). Conclusion The safety of the surgical meth- ods and the augmentation mate- rials used was of the highest pri- ority in the patient information and treatment. The decision was therefore in favour of the body’s own materials. This ruled out the risk of infection for the pa- tient, as well as immunological rejection of the transplant. “In its cancellous form, autologous bone […] is superior to all other bone substitutes with regard to its biological value, and is still considered […] today to be the ‘gold standard’ among augmen- tation materials.”17 In addition, autologous bone is partially os- teogenic and osteoconductive.18 When choosing the implant system, the focus was on the greater safety and better pre- dictability in the early treat- ment phase with immediate loading. As a result, only an im- plant system with the SLActive surface was an option. Studies have proved 60 per cent more bone–implant contact19 with the SLActive surface after two weeks compared with the SLA surface.20 Immediate loading of Straumann SLActive implants achieves a survival rate in ex- cess of 97 per cent after one year.21 Computer-aided, template- guided surgery via coDiagnostiX was used to place the implants. The procedure shows average horizontal deviations between the final and the planned posi- tion to 1 mm.22 12 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 Fig. 24 Fig. 25 page 11DTß ‘When choosing the implant system, the focus was on the greater safety and better predictability in the early treatment phase’

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