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ePaper created 2015-03-06, 14:42:46 | version 1.33.01
I 39 case report _ tissue management and CAD/CAM restoration I CAD/CAM 1_2015 the dark aspect of the nearby root of tooth #11 (Figs. 14 & 15). In both surgical appointments, ver- tical papillary incisions, which had been deemed not necessary, could be avoided. Prostheticprocedures A screw-retained provisional crown remained in situ for six months on the implant while maturation and stabilization of the peri-implant soft-tissue contourswereestablished.Duringthisperiod,modi- fications in form, contour and outline were effected to improve the aesthetic outcome using a light- curing composite material (Fig. 16). Proper implant placement allowed the establishment of an optimal final subgingival contour (Fig. 17). A customized im- pression coping was then fabricated to capture the transition zone contour created by the provisional restoration. For the final restoration, a CAD/CAM zirconia abutment was selected and Straumann CARESCADCAMwasusedtofabricatetheframeworks (Figs. 18 & 19). The screw access position allowed theuseofaone-piecerestoration.Theabutmentwas veneered using a pressable ceramic system. After the try-in and colour correction by the laboratory, the final crown was delivered to the patient and tightenedat35Ncm.Theaccessholewassealedwith gutta-percha and a light-curing composite resin. The prosthetic procedures on the root of tooth #11 involved the delivery of a longer golden post in order to reduce the risk of root fracture. For the samepurpose,itwasessentialtoperformprosthetic preparation of the palatal aspect of the gold abut- ment to create 1.5–2.0 mm of space for the zirconia frameworkandpressableceramic.Thefinalgoalwas to avoid interference during protrusive movements. _Conclusion The surgical and prosthetic challenge in this clin- ical case was to develop a natural scalloped mucosal line on the maxillary central incisors and to obtain a good aesthetic outcome with the prosthetic crowns, despitethevariousexistingdentalandskeletalasym- metries and the bone defects at the implant site. Of utmost importance was knowledge of the hard- and soft-tissue remodelling around the im- plantinregion#21andaroundtherootoftooth#11 after the surgical steps. A benefit resulting from the conservation of the rootoftooth#11wasthemaintenanceoftheinter- proximal height of the tiny bone peak, which pro- vided support to the papilla mesial to the implant. Furthermore, this approach was highly beneficial to the natural appearance of the prosthetic crowns (Figs. 20 & 21). The periapical radiograph (two-year follow-up) shows the stable crestal bone levels around the implant (Fig. 22)._ Riccardo Verdecchia,DMD, maintains a private practice in Rome (Italy) specializing in periodontology,implantdentistry and fixed prosthodontics.He is a member of the International Team for Implantology and the Società Italiana di Parodontologia e Implantologia (Italian society of periodontology and implantology).He can be contacted at riccardoverdecchia@hotmail.com. CAD/CAM_about the author Seit 20 Jahren bewährt Established since 20 years Eisenbacher Dentalwaren ED GmbH Dr.-Konrad-Wiegand Straße 9 63939 Woerth am Main Tel.: +49 (0)9372 9404-0 Fax: +49 (0)9372 9404-29 info@eisenbacher.de Wir freuen uns auf Ihren Besuch! We are looking forward to your visit! Halle/Hall 3.2 Stand/Booth A30/C39 AD CAD0115_36-39_Verdecchia 02.03.15 12:54 Seite 4 Tel.: +49 (0)93729404-0 Fax: +49 (0)93729404-29 CAD0115_36-39_Verdecchia 02.03.1512:54 Seite 4