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ePaper created 2015-02-10, 15:02:41 | version 1.33.01
Massimiliano Pisa Italy For some time, we have been benefitting from IPS e.max® CAD-on/Veneering Solutions (Ivoclar Vivadent), a working technique that combines li- thium disilicate (LS2) and zirconium dioxide (ZrO2). In addition to IPS e.max ZirCAD and IPS e.max CAD blocks (Ivoclar Vivadent), the tech- nique includes the use of a high-frequencyvibratingdevice (Ivomix, Ivoclar Vivadent) and a special thixotropic fusion glass-ceramic to join both of the ceramic structures. In this case report, we will demon- strate how to implement the technique step by step in order to achieve natural-looking and functional restorative results. In our case, the patient visit- ed the dentist because was she unhappy about her maxillary an- terior restoration. The ceramic material had flaked off at several sites and the function of the metal–ceramic bridge was im- paired. Consequently, she want- ed to have it replaced (Fig. 1). A detailed examination of the clinical situation established that, owing to severe bone atro- phy, teeth #11 and #21 were not suitable for anchoring a new dental prosthesis to them and that they would have to be ex- tracted.Sincethepatientwasun- willing to undergo augmentative procedures, placing an implant- retained prosthesis was not an option. Instead, we decided to in- stall a fixed bridge that would be anchored to abutment teeth #14 and #12 on one side and to teeth #24 and #22 on the other side. The area surrounding teeth #11 and #21 would have to be recon- structed with artificial gingiva. Treatment procedure After removal of teeth #11 and #21, the extraction site was allowed to heal for a sufficient period (Fig. 2). Meanwhile, the technician fabricated a diag- nostic temporary for evaluation of the aesthetic and functional parameters. In order to achieve a harmonious smile, the incisal edges of the anterior teeth had to be lengthened considerably (Figs. 3a & b). During the try-in, the contour oftheartificialgingivawasdeter- minedandshaped(Fig.4).Based on the wax-up, the technician created a temporary that was again evaluated in the oral cavity and adapted to the aesthetic and Easy and effective—Long-span bridges fabricated with the CAD-on technique Trends & Applications DENTALTRIBUNE Asia Pacific Edition No. 1+2/201512 Fig. 2Fig. 1 Fig. 3bFig. 3a Fig. 5Fig. 4 Fig. 6bFig. 6a Fig. 7 Fig. 9Fig. 8 Fig. 11Fig. 10 Fig. 12bFig. 12a Fig. 14Fig. 13 Fig. 15bFig. 15a Fig. 15dFig. 15c Fig. 17Fig. 16 Fig. 1: The patient required a new prosthetic restoration.Teeth #11 and #21 could not be saved and had to be removed.—Fig. 2: Situation after teeth #11 and #21 had been extracted and the site allowed to heal.—Figs. 3a & b: The aesthetic and functional parameters were evaluated in the patient’s mouth with the help of a temporary.—Fig. 4: The gingival contour was shaped in the oral cavity.—Fig. 5: The temporary in its planned,ideal situation.—Figs.6a & b:The temporary and master model were digitalised (CAD software).—Fig.7:The ZrO2 framework was prepared for milling (CAM software).— Fig. 8: The ZrO2 framework being milled.—Fig. 9: As the primary structure, the sintered ZrO2 framework provided the base for the digital production of the veneering structure. Fig.10:TheZrO2 frameworkonthemodel.—Fig.11:Situationaftermillingoftheveneeringstructure(LS2 ).—Figs.12a&b:Joiningtheframeworkandveneeringstructure(IPSe.maxCADCrystall./Connect). DTAP0115_12-13_Pisa 09.02.15 11:00 Seite 1 DTAP0115_12-13_Pisa 09.02.1511:00 Seite 1