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CAD/CAM - international magazine of digital dentistry

I case report _ implant-supported single-tooth restoration applicable the prosthodontist and the dental techni- cianworktogetherasanoptimalteamandusesuitable methods and materials. In the case presented, surgery and prosthetics were performed by the same dentist, who had been working together intensively for many years with the dental technician in the same location. At the beginning of treatment, the patient presented to the laboratory for an aesthetic analysis to give the dental technician a detailed understanding of the situation. In order to obtain adequate tissue volume in the implantation area, the surgeon employed proven bone and soft-tissue surgical procedures. These in- cluded using a bone mixture for augmentation and a tunnel technique for thickening the buccal soft tis- sue.10,11 The literature shows that stable tissue volume and a constant marginal soft-tissue border can be achievedinthisway5,12 eveninthecaseofanimpaired implantation site with missing bone lamella.8, 13 This procedure is not (yet) recommended in the current consensus statements by the professional associa- tions owing to difficult predictability of individual results.14 _Analogue and digital A large part of the treatment and technical work steps were performed with conventional surgical prosthetic and craft-dominated technical dental methods (analogue). Computer-supported planning wasnotemployed,sothatthesurgeonwasnotguided butimplantedfreelyinaccordancewiththesurround- ingstructures.Thisrequiresapreciseclinicalandradi- ographic analysis of the initial situation, appropriate planning and a high degree of expertise. Impression takingalsofollowedconventionaltechniques. A speciality here is the use of a two-part hybrid abutment as the base for the pressed ceramic veneer. In order to obtain a biochemically optimal titanium bondingbase,astraightCONELOGEsthomicabutment was customised in place of the alternative CAD/CAM component. The secondary zirconium oxide abutment was waxed up. Then, both components were scanned. ThisiswheretheCAD/CAMprocesscameintoplaywith the fine-tuning of the design on the screen and ma- chine fabrication of the zirconium oxide secondary abutment.Despiteusingatitaniumprimaryabutment, the dental technician achieved a natural light effect bytheconsequentuseoffluorescingmaterials. As all components of the implant-supported re- storation were bonded in the laboratory, the dentist was able to screw them in place together as a single piece and in a single session. This meant fewer treat- ment sessions for the patient, who did not have to returntothepracticeafterimpressiontakinguntilfinal insertion. The aesthetic try-in before final bonding of the individual parts was performed in the laboratory. The procedure described is only possible in close co- operation and with full confidence between the team partners._ Editorial note: A list of references is available from the publisher. 32 I CAD/CAM 3_2014 Fig. 40_The palatally inserted crowns and the sealed screw access channel of the implant crown. Fig. 41_The X-ray check-up confirmed successful osseointegration and the natural emergence profile of the implant-supported restoration. Fig. 42_The close-up shows the healthy peri-implant soft tissue and the natural surface of the restorations. Fig. 43_The side profile also shows the natural contours of the restoration and the successful interplay between red and white. Fig. 44_The patient’s relaxed smile confirmed that the effort and attention to detail were appreciated. Dental technician: Enamelum et Dentinum Andreas Nolte Königsstraße 46 48143 Münster Germany www.enamelum-et-dentinum.de Fig. 43 Fig. 40 Fig. 44 Fig. 41 Fig. 42 Joint practice Drs Happe Schützenstraße 2 48143 Münster Germany info@dr-happe.de www.dr-happe.de CAD/CAM_contact CAD0314_26-32_Happe 22.08.14 14:25 Seite 6

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