today Chicago Midwinter Meeting Feb. 28

exhibitors20 Chicago Midwinter Meeting — February 28, 2015 By Timothy F. Kosinski, DDS, MAGD n With continual improvements in the design and production of implant systems and restorative components, the consistent results, predictability and long-term prognosis offered by implant therapy is making the treat- ment an increasingly popular tech- nique for replacing missing teeth. The esthetics, durability and pre- cise customization offered by modern prosthetic components enable clini- cians to provide ideal final restora- tions their patients can depend on. For the best results and maximum efficiency, implant therapy should be approached comprehensively, with the final result visualized from the outset. Technology has advanced to the point where smile design, emergence profile and margins can be established prior to any surgical intervention, giving clinicians a clear picture of the optimal prosthetic outcome that can be carried through each phase of treatment. The Inclusive® Tooth Replacement System (Glidewell Laboratories, New- port Beach, Calif.) simplifies this approach by providing everything needed for an implant case in a sin- gle package, building toward the final restoration with patient-specific components that begin shaping the patient’s soft-tissue contours immedi- ately following surgery. Experienced dental technicians use the latest in CAD/CAM technol- ogy to design custom abutments that sculpt the gingival contours dur- ing the healing phase, setting up a smooth, predictable transition to the final custom abutment and crown. Until recently, surgical placement of the implant was the primary con- cern.Improvementsindentalimplant design have led to better initial sta- bility and less crestal bone loss over time. While positioning and angulat- ing are crucial, achieving the most esthetic final result possible is also nowofparamountimportanceifseek- ing to meet or exceed patient expecta- tions. The Inclusive Tooth Replacement System takes significant strides in facilitating the creation of superior, more predictable esthetics. With the optimal emergence profile driving the design process, clinicians now have the necessary tools to manage soft-tissue contours with custom com- ponents that approximate the root design and structural anatomy of a natural tooth. The case that follows illustrates how an all-inclusive, prosthetically driven treatment protocol assists the clinician in achieving an excellent clinical outcome while streamlining the surgical and restorative phases of treatment. Because the case involves the replacement of a central incisor in the anterior, where creating an ideal emergenceprofileisespeciallyimpor- tant, the esthetic benefits of this approach are particularly evident. Case report A55-year-oldfemalepresentedwitha fractured maxillary left central inci- sor (Fig. 1). After careful intraoral and radio- graphic examination, it was deter- mined that an implant could be pre- dictably placed in the bone without complication. The primary goal was for the ultimate emergence profile of the final restoration to match that of the natural tooth being replaced and that of the adjacent central incisor. A flapless surgical protocol was selected to retain as much gingival tissue as possible. The laboratory pro- duced a surgical stent to assist with theinitialorientationofthepilotdrill. A radiograph was taken to ensure proper mesial-distal positioning and equal spacing between the adjacent natural teeth. Once proper angula- tion was verified, typical implant techniques were used. Treatment began with the atrau- matic extraction of the root. Main- taining the facial plate of bone was critical to facilitating optimal tissue healingandallowedforflaplessplace- ment of the dental implant. Digital radiographs were used before, during and after surgery to ensure ideal implant angulation and depth. A pilot drill established the desired depth, and the apex of the implant was safely and effectively positioned in line with the roots of the adjacent teeth. Following implant placement, the choice was made to not immediately load the implant with a transitional crown because sufficient primary stability was not achieved. The custom healing abutment was placed (Fig. 2), and because the tooth being replaced was in the esthetic zone, a removable partial denture was used as a transitional appliance. The custom contours of the heal- ing abutment effectively managed the patient’s soft tissue. For added esthetics, the maxillary right central incisor crown was replaced following preparation. Upon completion of the healing phase, ideal gingival contours were evident (Fig. 3), which made deliv- ery of the final restoration a smooth endeavor that was comfortable for the patient and required no chairside adjustments (Fig. 4). Conclusion As demonstrated by the natural mar- gins, soft-tissue contours and emer- gence profile achieved in this case, a prosthetically driven approach to implant dentistry provides excellent clinical outcomes. Visualizing the final restoration from diagnosis and treatment planning through delivery of the final abutment and crown helps to ensure a predictable result. The Inclusive Tooth Replacement System simplifies this approach by harnessing patient-specific tissue contouring and an all-inclusive clini- cal protocol to guide cases toward a functional and esthetic conclusion, with each step of the restorative proc- ess setting up the next for success. Controlling tissue contours with a prosthetically driven approach to implant dentistry 5 Fig. 1 (Photos/Provided by Glidewell Laboratories) 5 Fig. 3 5 Fig. 4 5 Fig. 2 Here in Chicago For more information on the Inclusive Tooth Replacement System, stop by the Glidewell Laboratories booth, No. 4220. Fig. 35

today Chicago Midwinter Meeting Feb. 28

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