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6 Dental Tribune Middle East & Africa Edition | November-December 2014mCME Utilizing the Tempcap abutment with CAD/CAM Combination of Tempcap, in-office CAD/CAM and e.max allows for final restoration Fig. 1. Tempcap abutment. Fig. 9. Tempcap digitized. Fig. 5. Temporization form and function. Fig. 3. Tempcap with Straumann im- plant. Fig. 11. Development of emergence pro- file. Fig. 7. Digitization with E4D camera (Editorial note: Planmeca E4D Tech- nologies). Fig. 2. Retentive pins. Fig. 10_Digitized delineation of Temp- cap. Fig. 6. Tempcap on soft-tissue model with Ankylos implant (DENTSPLY Implants). Fig. 4. Use of existing instruments. Fig. 12. Occlusal view of restoration. Fig. 8. Digitized images of arch. > Page 7 By Dr. Les Kalman, USA T he E4D in-office CAD/ CAM unit (Editorial note: Planmeca E4D Technolo- gies) has been employed in an investigative laboratory study to design and mill an uncon- ventional IPS e.max restoration that would be coupled with the Tempcap as a final implant-sup- ported crown. The combination of the Tempcap, in-office CAD/ CAM procedures and IPS e.max allows the clinician to create an immediate final restorative product with ideal characteris- tics. The procedure is a simple, ef- ficient and effective solution for the restoration of implants. Introduction The temporization of a dental implant following surgery, par- ticularly in the anterior region, is a necessary procedure. The temporization allows for surgi- cal healing, preservation of the gingival architecture and, most important, replacement of a tooth in the edentulous space for patient acceptance. Several techniques for the temporization exist, but the process has proved to be time-consuming and frus- trating. The Tempcap abutment and the process for temporiza- tion were created to provide a simple yet effective approach.1 With the advent of CAD/CAM technology and e.max, the po- tential of the Tempcap to act as a final abutment seemed likely and suitable for investigation. Background Following the surgical place- ment of a dental implant, sev- eral requirements must be met to maximize healing and osse- ointegration of the implant body to bone: – Minimal forces, if any, should be exerted on the implant body, permitting proper healing and preventing a non-osseous un- ion.2 – The gingival architecture must bemanagedmeticulouslytopre- vent contamination, minimizing the risk of peri-implantitis and possible failure.3 – There must be sufficient time for the process of osseointegra- tion.4 – Temporization and immediate restorations should not violate these factors.5 The Tempcap is a healing cap and restorative platform com- bined (Fig. 1). It has an all-metal construction, and it contains two to three retentive pin projections (Fig. 2). Tempcap is available in different widths and heights to accommodate different implant sizes (Fig. 3) and is compatible with existing instrumentation (Fig. 4). The function of the Tempcap is: – to allow for optimal gingival healing; – prevent contamination of the surgical field; – minimize forces and micro- vibrations on the implant; – facilitate the simple yet suc- cessful restoration of the implant (Fig. 5). CAD/CAM stands for computer- aided design and computer-aid- ed manufacturing. CAD enables the individual to digitally capture an image of a prepared tooth or structure and then design an in- direct (out of the mouth) resto- ration by using software.6 After the ideal restoration has been produced, the design is then fabricated out of a material by a milling machine. In-office E4D units (Editorial note: Plan- meca E4D Technologies) are currently available to allow for immediate chairside fabrication without the use of a commercial laboratory. IPS e.max (Ivoclar Vivadent) is a relatively new metal-free dental material used in indirect resto- rations. It is an aesthetic mate- rial composed of lithium disili- cate and has ideal physical and aesthetic properties, allowing it to be the first choice for CAD/ CAM restorations. IPS e.max has strength second only to gold and has the ability of detailed CAM production.7 Methodology The Tempcap was selected and placed on an Ankylos (DENTSP- LY Implants) implant body (mas- ter cast with soft tissue) (Fig. 6). Digitization was achieved by using an E4D camera (Editorial note: Planmeca E4D Technolo- gies) (Fig. 7), in which several images were captured to com- pile an accurate image (Figs. 8 & 9). CAD design was used with E4D software (Editorial note: Planmeca E4D Technologies) to determine and delineate mar- gins (Fig. 10). Tooth design was initiated incor- porating several parameters: – ideal aesthetics and emer- gence profile (Fig.11); – adequate proximal contacts; – appropriate occlusal scheme; _material thickness require- ments; – internal surface morphology to adapt to Tempcap; – design that can be milled via CAM technology. Numerous design iterations were required to achieve the de- sired design requirements (Figs. 12–14). IPS e.max was selected for milling (Fig. 15) and was executed by an E4D CAM unit (Editorial note: Planmeca E4D Technologies) (Fig. 16). Milling limitations, such as bur contact and prosthesis fracture, required CAD design modifications. Reit- erations in CAD/CAM design were carried out until a suc- cessful restoration was achieved (Fig. 17). The unfired IPS e.max crown was tried for fit and aesthet- ics and then subsequently fired (Fig. 18), resulting in its colour change. The crown was further stained, glazed and fired (Fig. mCME articles in Dental Tribune have been approved by: HAAD as having educational content for 2 CME Credit Hours DHA awarded this program for 2 CPD Credit Points Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. CAPP designates this activity for 2 CE credits.