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ePaper created 2014-08-26, 21:44:32 | version 1.30.01
case report _ implant-supported single-tooth restoration I apical position of the implant shoulder. Therefore, the dental technician decided on a considerably longer, straightCONELOGEsthomicabutment,whichwascus- tomised for use as a titanium bonding base (Figs. 27–29). He modelled a secondary abutment with wax on the customised titanium base (primary abutment), which was to be fabricated from zirconium oxide. Subsequent bonding with the titanium base resulted in a hybrid abutment with full anatomical contours, both in the palatally and subgingivally positioned emergenceareathroughthesofttissue.Roomwasleft onthebuccallyvisibleareaforapressedceramicveneer to be fixed by bonding (Fig. 30). Using a double scan, the dental technician imported the 3-D shape of the primary abutment and the wax model of the second- ary abutment into the planning software (Abutment Designer,3Shape;Fig.30). Then the secondary abutment was ground from zirconium oxide ceramic with CAM technology and immersed unsintered into a fluorescent solution (Fig. 31). The screw channel was prepared prior to sintering. As zirconium oxide cannot be etched, the dental technician had to fire a thin layer of etchable, highly fluorescent zirconium oxide veneer ceramic on to the buccal surface and preparation margin of thehybridabutmentpriortomodellingthecapforthe pressedceramicveneer(Fig.32).Fluorescenceensures the transmission of light in the gingival area. This has a positive effect, particularly in the case of a thin gingiva. Then, the dental technician fabricated and veneered the pressed ceramic caps for the crowns andveneers(Figs.33–35). After a successful aesthetic try-in in the laboratory (Figs. 36 & 45), the individual parts were combined. First, the titanium base was sand-blasted and condi- tioned, then the secondary zirconium oxide abutment was conditioned. Both parts were bonded with special composite. Then the inner side of the veneer and the sintered zirconium oxide veneer ceramic of the hybrid abutment were etched with hydrofluoric acid, con- ditioned and bonded with dual-curing composite (Fig.37).Then,thetransitionareasweresmoothedand polished(Fig.38). _Insertion The crowns were mounted by bonding and the implant-supported veneer crown was screw-retained (Figs. 39 & 40). This was followed by a careful check of the approximal contacts and function. The final X-ray confirmed successful osseointegration of the implant andharmoniousemergenceoftheimplant-supported restoration from the bone (Fig. 41). Figures 42 to 45 show the aesthetically successful outcome and a very satisfiedpatient. _Discussion The example demonstrates successful immediate implantationintheanteriormaxillaofafemalepatient withathinbiotypeandhighsmileline.Inaddition,the buccalbonelamellawasmissing,sothattheboneand soft tissue had to be augmented as part of immediate implantation—withoutpreparingaflap.Thisdemand- ing task can only succeed when the surgeon and if Fig. 34_Modelling of the mamelon for the implant-supported veneer from a palatal view. Fig. 35_After glaze firing and polishing, the natural anatomy and surface characteristics of the restoration were checked. Fig. 36_Aesthetic try-in: The patient and her dental technician, Andreas Nolte, appreciating the highly successful outcome and nearly completed treatment. Fig. 37_The pressed ceramic veneer was mounted on the previously bonded hybrid abutment by bonding with dual-curing composite. Fig. 38_The transitions between the abutment and the veneer were smoothed and polished to a high gloss with a brush and polishing paste. Fig. 39_The implant restoration is screw-retained. For biomechanical reasons, the screw access channel was placed in the zirconium oxide section. I 31CAD/CAM 3_2014 Fig. 34 Fig. 36Fig. 35 Fig. 37 Fig. 39Fig. 38 CAD0314_26-32_Happe 22.08.14 14:25 Seite 5