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ePaper created 2014-08-26, 21:44:32 | version 1.30.01
I case report _ implant-supported single-tooth restoration Fig. 28_The Esthomic abutment, extended with a bonding aid, shows the palatal positioning of the access channel. Fig. 29_Customising the primary abutment ensures sufficient coating strength of the zirconium oxide abutment. Fig. 30_The titanium base and the completed model of the secondary abutment were scanned in the laboratory. Buccal space was left for the planned pressed ceramic veneer. Fig. 31_The sintered abutment left without and right with fluorescent solution treatment. Fig. 32_Firing of a highly fluorescent, etchable zirconium oxide veneer ceramic. The shape of the abutment was optimised prior to modelling the press cap. Fig. 33_The layer thicknesses for veneering the pressed ceramic caps were checked with the aid of the vestibular, twice-divided silicone index. bone augmentation material were used to prevent resorption(Figs.10&11). In order to obtain the best possible soft-tissue conditions in the sense of a thicker gingival type, the surgeon harvested a connective-tissue graft from the palate.UsingthetunneltechniqueaccordingtoAzzi,9–11 this was pulled between the bone granulate and the buccalsofttissueandfixedwithamonofilament,non- absorbable suture material (Fig. 12). Then a CONELOG wide-body healing cap (4 mm height) was screwed in andthetemporarybridgecemented(Fig.13).Thissup- ported the soft tissue, but did not contact the healing cap, so that the lower section of the pontic could be cleaned with super floss. Figures 14 and 15 show the post-operativeX-rayandthesituationatthecheck-up oneweekafterimmediateimplantation. After three months of implant healing, the peri- implant and periodontal tissues were ready for final impression taking (Figs. 16 & 17). To this end, double 0 suturessoakedinglycerinewereplacedinthesulciand thepreparationbordersplacedslightlysubgingivallyas part of final fine preparation. Then a thicker retraction cord, strength 0, soaked in epinephrine was placed (adrenaline; Fig. 18). The healing cap was unscrewed (Fig.18)andaCONELOGimpressionpostforopentrays screwed in (Fig. 19). Impression taking was performed after drying and removal of the thick retraction cord (Fig. 19) in one step with an individual open tray and a two-phase polyvinyl siloxane (A-silicone). Following arbitrary transfer of the occlusal relations with a bite fork, facebow and bite registry, the healing caps and temporary bridge were reinserted. A temporary crown wasfabricatedfortooth22(Fig.20).Themarginalgin- giva in the region of the implant had to be moved slightly in an apical direction with the definitive restorationowingtotheexcesstissue. _Fabrication of abutments and final crowns Using super-hard plaster, the dental technician fabricated root-shaped (conical) stumps to prevent rotation. These were placed in the impression to fabri- cate the master model and extended with wax pins (Figs.21–23).Anewwax-upwaspreparedbasedonthe updatedaestheticanalysisandtheoutercervicalcon- tour of the implant restoration was transferred to the model(Fig.24).Theanatomicalshapeoftheemergence profile was then created with a fine milling machine. Theimplantcrownwasthusgivenanaturalemergence contour. The papillae were slightly sharpened and smoothed to give an optimal gingival contour. The optimised shape of the papillae avoided concavities occurring later in the cervical, slightly subgingival ceramicareas,whicharedifficulttocleanandcanlead to irritation of the gingiva (Fig. 25). The wax-up was fittedwithapinattheimplantposition,whichengaged with the implant interface for better fixation of the wax-upduringtry-in(Fig.26). A suitable abutment was selected from the CONELOG Esthomic abutment set and the silicone in- dexes based on the wax-up. In this case, the CONELOG Titanium base CAD/CAM was too low owing to the 30 I CAD/CAM 3_2014 Fig. 31 Fig. 33Fig. 32 Fig. 28 Fig. 30Fig. 29 CAD0314_26-32_Happe 22.08.14 14:25 Seite 4