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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
case report _ restorative dentistry I I 35CAD/CAM 1_2016 Figs. 18a & b_The BioTemps prostheses were tried in and fit the patient well. Fig. 19_The interim BioTemps restorations were evaluated for proper occlusion, function and esthetics. Fig. 20_Based on the final-approved BioTemps prostheses, the final PFM restorations were fabricated on the master casts. Fig. 21_Final panoramic radiograph illustrates proper placement and orientation of the dental implants. patient’s immediate dentures in place, providing the labwithatemplateforthedefinitivedesignofthePFM restorations(Fig.11). ThelabpouredworkingcastsfromtheVPSimpres- sionsofthepatient’sedentulousarchesandproduced wax occlusal rims (Fig. 12). After seating the wax rims in the patient’s mouth and tightening the temporary cylinder screws, the jaw relationship records were taken (Fig. 13). Note that the patient’s vertical dimen- sion had virtually collapsed due to the extensive wear tohisteeth.Aftermeasuringthedistancebetweenthe patient’s nose and chin during maximum intercuspa- tion, the lab was instructed to open the patient’s bite by 2 mm. Next, the lab used CAD software to design Inclusive® Titanium Custom Abutments (Glidewell Europe GmbH; Frankfurt/Main, Germany) for both arches based on the scanned working models. The CAD/CAM-produced custom abutments were seated ontheworkingmodelssotheirfitcouldbeverifiedand they could be used in the development of the defini- tive prostheses (Figs. 14a & b). Based on the jaw rela- tionship records and the impressions of the patient’s immediate dentures, the lab prepared a diagnostic wax-up to help determine the initial design for the PFM restorations (Fig. 15). After finalising the initial design, BioTemps prostheses were fabricated from polymethyl methacrylate (PMMA) material, which is versatileenoughtoeasilyaccommodateadjustments atthetry-inappointment,yetdurableenoughforpro- visionalisation(Fig.16).Theworkingmodelsweresent out along with the custom abutments and BioTemps interimrestorationsforpatientevaluation.Atthenext appointment, the titanium custom abutments were transferred to the patient’s mouth using the acrylic delivery jigs provided by the lab (Fig. 17). The custom abutments achieved a precise fit and were thus tight- ened to the appropriate torque, establishing ideal soft-tissue margins and support. Complete seating was verified radiographically, and the screw access holeswerecovered. Next, the BioTemps prostheses were tried in and exhibitedanaccuratefit(Figs.18a&b).Theprovisional restorations were attached to the abutments using temporary cement, and the phonetics,aesthetics, bite and function were evaluated (Fig. 19). Minor modifi- cations were made to the BioTemps prostheses, and the patient wore the BioTemps provisionals for an interimoffourweeks.Thistrialperiodwasessentialin verifying that the patient was happy with the look, comfortandfunctionoftheprostheticdesignsbefore the final PFM restorations were fabricated. After pa- tient approval was provided, alginate impressions weremadeoftheBioTempsprostheses.Modelsofthe final-approvedBioTempsrestorationswerefabricated fromtheimpressions,andanewbitewastakensothe definitive prosthetic designs could be adjusted ac- cordingly. Crown & bridge impressions were taken of thefinalcustomabutmentsinplaceandwouldbeused bythelabtopourmastermodels,uponwhichthefinal PFMprostheseswouldbeproduced.Thegingivalareas forthefinalPFMsweremarkedontothemodelsofthe BioTemps restorations, and the case was returned to the lab along with instructions for final adjustments. The final PFM prostheses were fabricated by layering Fig. 19 Fig. 21Fig. 20 Fig. 18a Fig. 18b CAD0116_30-36_Nazarian 21.01.16 10:52 Seite 5 CAD0116_30-36_Nazarian 21.01.1610:52 Seite 5