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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
I case study _ backward planning modern implant dentistry with its simplified surgi- cal and prosthetic protocol. Prosthetic restoration withpatient-specificATLANTISabutmentshasbeen greatly simplified by the innovative connection de- sign (one position only). The individually fabricated ATLANTIS Abutment for the ASTRA TECH Implant System EV is only placed in a single position. A malposition abutment is thus a thing of the past. A tooth-supported SIMPLANT SAFE Guide was ordered in the SIMPLANT software (Fig. 2) and the ImmediateSmilefeaturingATLANTISAbutmentop- tion was chosen. In this fully digital workflow, the SIMPLANTplanisusedtocreatetheSIMPLANTGuide aswellasanATLANTISAbutment.Adesignproposal of the abutment was sent to the treatment team, whichcanbeloadedintoSIMPLANTforreviewofthe case, and modified if necessary using ATLANTIS 3D Editor (Fig. 3). After approval of the construction, CAM-supported fabrication of the abutment took place in the desired material; in this case, titanium. Fabricationofthetemporarycrown In the ATLANTIS WebOrder, ‘dispatched’ status appears after the abutment is ordered, indicating thattheATLANTISAbutmentCoreFilecanbedown- loaded.Thecorefiledatacorrespondtoanexactre- productionoftheATLANTISAbutmentandactasthe basis for fabrication of the temporary crown. As the data are made available in an open format, it is pos- sible to work with conventional CAD software and ordinary CAM technology (Figs. 4 & 5). To simplify the design process, the core file displays the abutment without a screw channel. On the outer surface of the planned abut- ment and in the region of the cervical margin, the file cor- responds exactly to the actual abutment.Throughanarticula- tor integrated in the software, the lines of movement can be tracked and static and dynamic occlusion adjusted. Following construction, the temporary crownwasfabricatedbythedentallaboratoryfrom a high-quality composite using CAD/CAM (Fig. 6). Planningthesurgicalprocedure The implant position and alignment as de- termined from the three-dimensional data must be transferred to the patient during the surgery. Drilling of the implant site should correspond as accurately as possible to the position previously simulated in the software. To ensure this, a drilling template (SIMPLANT SAFE Guide) and necessary drills were ordered in the SIMPLANT online shop as described previously. This innovation of ordering all drilling components together with the template, based on the planning, facilitates implant place- ment enormously. The dentist receives a list of drills required, and they can be deselected if the dentist hasalreadyreceivedthemforuseinapreviouscase. In the present case, only the sleeves needed for the individual patient were required. Afterbeingordered,thetemplatewasfabricated by stereolithography (a type of 3-D printing) in the SIMPLANT production site. Placementoftheimplant Placement of the implant with gradual prepa- ration of the bone cavity. Prior to the surgical pro- cedure, the drill template, the individual set of drills and drill protocol, the patient’s custom abutment, and the temporary crown were all at hand so that, assuming primary stability was achieved, immediate restoration with the definitive abutment and temporary could take place. All components were disinfected, and the patient was given local anaesthesia. The drill template wasfixedsecurelyontheneigh- bouring teeth, and the soft tis- sue was first pierced with a tis- sue punch so that the implant Fig. 11_Conical preparation of the crestal bone with the A/B drill. Fig. 12_The large cam on the placement instrument is in line with the groove in the SIMPLANT guide to ensure that the implant and abutment are positioned exactly. Fig. 13_Without having to remove the drill template, the implant could be placed with the EV-GS Implant Driver. Fig. 14_The implant was restored with the custom abutment and subsequently with the temporary crown in only one session. 22 I CAD/CAM 1_2016 Fig. 13 Fig. 14 Fig. 11 Fig. 12 CAD0116_20-23_Mertens 21.01.16 10:49 Seite 3 CAD0116_20-23_Mertens 21.01.1610:49 Seite 3