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CAD/CAM - international magazine of digital dentistry, Italian Edition, No. 3, 2015

3_201516 special _ digital technologies At the same time, we get to know if there is sufficient bone support for the implant or if we have to graft. The ability to plan any grafting procedure in advance of the operation gives a better predictability, patient compliance and ef- fective scheduling of the surgery. Looking at the intraoral photos and the planned 3-Dimplantpositionwe make the decision to do open or closed surgery. If possible we will do a tissue punch because it is faster and less traumatic to the tissue and the patient. Our patients love the flapless insertion of implants. There is virtually no post-oper- ative bleeding, swelling, sutures or pain compared to raising a flap. I admit that we often have to do some type of grafting but when I am able to do a flapless procedure, I will do it. (It is a fast procedure and a great internal marketing opportunity.) At this point we make a decision whether we want a customised Atlantis titanium abutment, a customised titanium/zirconia abutment or a screw-retained crown. We always use customised abutments for cemented solutions to make sure the risk of cement residuals is minimal. The customised abutments are designed with a preparation margin of 0.5 mm, subgingivally facially and aproximally. On the oral surface, the margin is placed 1 mm above the gingiva. This is impossible with stock abutments. Implant Direct has some implants that are delivered with a stock abutment. This abutment can be modified and scanned with an intraoral scanner and with CAD/CAM technology we can mill a customised zirconia abutment part that will be glued to the stock abutment. The gingiva will establish a strong hemidesmosome attachment to the zirconia and thereby create a better 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 posterior and only in selected cases when we think we need easy retrievability. I admit there are many different 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 temp- Fig. 4b Fig. 4b Fig. 5a

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