Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-09-09, 12:07:54 | version 1.38.0
I technique _ veneering options comfort and chewing deficiencies. He was wearing two severely worn, 20-year-old complete dentures and requested implant-supported fixed restorations. Followingdiagnosticandradiographicexaminations, the definitive treatment plan compensated for the extensive resorption of alveolar ridges (hard- and soft-tissue architecture) via prosthetic means. In addition to functional and aesthetic rehabilita- tion,thepatientneededacost-efficientsolutionthat would not require high maintenance costs. To meet his needs and expectations, the treatment team de- cided to go for the following solution: four Nobel- Active implants were placed in both the maxilla and the mandible according to the All-on-4 concept. Treatment planning and execution were carried out with NobelClinician/NobelGuide technology, and an immediate provisional restoration was provided. To reduce additional costs for the patient, the exist- ing dentures were transformed into an immediate, screw-retained provisional (readapted to a correct VDO).Followingafour-monthhealingperiodtoallow for osseointegration of the fixtures, the provisional was subsequently replaced with definitive resto- rations, i.e. NobelProcera Implant Bridge Titanium veneered with conventional denture teeth and cold- cure acrylics (Figs. 1–7). Whythisapproach? The team’s rationale for selecting this approach has to do with a number of clinical and technical advantages. First of all, the titanium framework represents an economical solution, which also demonstrates bene- ficial biomechanical properties in combination with Nobel Biocare’s Multi-unit Abutments (MUA). Not only does this solution provide excellent peri- implant, soft tissue biocompatibility, it is also asso- ciated with a straightforward handling protocol for both the clinician and the dental technician. MUAs provide ease of use through accessibility. At the same time, their use supports biologic sta- bility of the peri-implant tissues, as this critical interface remains undisturbed during the change from a provisional to final restoration (e.g. abut- ment-level impression and fixation of the definitive framework). From a technical and longevity perspective, the performanceofthechemicalbondbetweentitanium and acrylic has ample scientific background, can be easily achieved, and is stronger than a zirconia- ceramic bonding. What is more, costs for the patient can be signi- ficantly reduced through material selection and the choice of prefabricated standard acrylic denture teeth.Infact,thereareanynumberoftime-andcost- saving production steps in the dental laboratory when this option is chosen. Reduced maintenance costs in case of late pros- thetic reintervention can be expected and most re- pairs can be performed intraorally. Finally, this restorative approach produces highly aesthetic results thanks to an optional outer layer of compositeresinthatcanbeaddedafteracut-backof the denture teeth (depending on the aesthetic needs and expectations of the patient). _Case 2 Drs Mario Imburgia and Giovanni Cricchio, and Ceramicists Angelo Canale and Angela Giordano of Fig. 6_Finalised maxillary restoration. Gingival tissues were manually layered in an ‘onion-like’ mode, with a thicker inner layer of cold cure acrylic resin and a thinner outer layer of pink composite material. Fig. 7a & b_Intraoral view of maxillary and mandibular restorations retained by four NobelActive implants each (a). Radiographic view of maxillaryandmandibularrestorations, each of which are retained by four NobelActive implants (b). _Case 2 (Images courtesy of Drs Mario Imburgia and Giovanni Cricchio, and ceramicists Angelo Canale and Angela Giordano) Fig. 8_Preoperative clinical view. Following clinical and radiographic examination, the teeth of the upper arch were evaluated as hopeless. The primary request of the patient was to optimise function and esthetics throughminimallyinvasivetechniques. Fig.9_Intraoralocclusalviewofthe zirconiaimplantbridge.Basedonan accuratesurgicalplan,itwaspossible tomanufactureaframeworkdirectly screwedontotheimplants.The morphologyoftheframeworksensures uniformthicknessesoftheveneering ceramic,reducingtheriskofchipping. 38 I CAD/CAM 3_2015 Fig. 7b Fig. 6 Fig. 7a