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cone beam – international magazine of cone beam dentistry

I special _ digital technologies thepatient.Ourpatientslovetheflaplessinsertionof implants. There is virtually no post-operative bleed- ing, swelling, sutures or pain compared to raising a flap. I admit that we often have to do some type of graftingbutwhenIamabletodoaflaplessprocedure, I will do it. (It is a fast procedure and a great internal marketing opportunity.) At this point we make a decision whether we wantacustomisedAtlantistitaniumabutment,acus- tomised titanium/zirconia abutment or a screw-re- tained crown. We always use customised abutments for cemented solutions to make sure the risk of ce- mentresidualsisminimal.Thecustomisedabutments are designed with a preparation margin of 0.5mm, subgingivally facially and aproximally. On the oral surface,themarginisplaced1mmabovethegingiva. This is impossible with stock abutments. Implant Direct has some implants that are delivered with a stock abutment. This abutment can be modified and scannedwithanintraoralscannerandwithCAD/CAM technology we can mill a customised zirconia abut- ment part that will be glued to the stock abutment. The gingiva will establish a strong hemidesmosome attachmenttothezirconiaandtherebycreateabetter seal to the surrounding environment. Furthermore, it will allow us to produce every prosthetic part in- house and save time. Screw-retained crowns are primarily used in the posteriorandonlyinselectedcaseswhenwethinkwe needeasyretrievability.Iadmittherearemanydiffer- ent philosophies about this subject. And I admit it is harder to remove excess cement in the posterior. We use a semi-permanent composite cement or tempbondtocementallourrestorations.Wewantall restorations to be retrievable in case of future com- plications. Atthispointweknowhowthefinalresultwilllook like. The abutment design and the position of the im- plant. We know whether or not we need grafting and 16 I cone beam3_2015 Fig. 4a Fig. 4b Fig. 5a

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