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CAD/CAM - international magazine of digital dentistry

Common posterior-region challenges Nobel Biocare brings innovative technology to the posterior region By Michael Stuart Restoring single molars is a common indication for most clinicians placing implants, but that doesn’t mean it’s straightforward. Here we look at how to overcome four challenges frequently encountered in the posterior region. If you’re taking an immediate placement ap- proach, then large molar extraction sockets can make it difficult to achieve sufficient stability. Large molar sites The need for a large molar crown means that additional considerations have to be taken when it comes to the emergence profile. Restorations that are significantly wider than the implant platform could, at best, leave space where food can become trapped. At worst, they could be det- rimental to the marginal bone. In both eventualities, you may have patients com- ing back with complaints. To try to help avoid these issues, you can use wide-platform implants, such as those found in the NobelActive and NobelParallel Conical Connection systems. You can also further improve the emergence profile by using healing and tem- porary abutments designed specifically for the molar region. Limited accessibility The reduced space and light in the posterior re- gion can make placing the restoration tricky. And working at the back of the mouth means there’s a high risk of the patient aspirating any small components that can come loose. Improve accessibility by selecting an abutment with an angulated screw channel. Being able to position the screw access hole towards the lin- gual or mesial aspects makes it easier to reach. The right tooling can also improve handling. Nobel Biocare’s unique Omnigrip Screwdriver is designed for a strong grip on the screw to limit the chances of it detaching in the patient’s mouth. This offers a little extra peace of mind, particular- ly when you’re working in the posterior. Excess cement Case studies have indicated that excess cement can have a detrimental effect on peri-implant tissue health. Despite the risks, a survey of 400 dentists by Wadhwani and Piñeyro (Int J Oral Max- illofacial Implants 2012) found that some place up to twenty times more cement than they need. An overload of this scale means that up to 95% of the cement that’s placed extrudes at the restor- ative margin. With the restorative margin often below the gumline, this can pose real problems, particularly in the molar region, where acces- sibility and visibility make removal of cement especially difficult. You can avoid this issue entirely by using a screw-retained restoration like the NobelProcera FCZ (full-contour zirconia) Implant Crown. As even the adapter is mechanically retained, the restoration is completely cement-free. Alternatively, Wadhwani and Piñeyro suggest a technique for minimizing excess cement by cre- ating a chairside copy abutment that serves as a controlled applicator for the cement. High occlusal forces If your restorations are going to withstand the high occlusal forces experienced at molar teeth, they need to be strong. Those created specifically for the posterior re- gion, like the NobelProcera FCZ Implant Crown, are designed to handle these de- manding conditions in the long term. High forces can also lead to veneer chip- ping. As the NobelProcera FCZ Implant Crown is a monolithic full-contour option, it overcomes this challenge too, as no ve- neering is required. Four problems, one complete solution To overcome all these challenges, we’re bringing innovation back to the posterior region. Our new complete posterior solution combines wide-platform NobelActive and NobelParallel CC implants with anatomically shaped PEEK Tempo- rary and Healing Abutments. Then, for the final restoration there’s the high- strength, cement-free FCZ Implant Crown with the option for an angulated screw channel. In combination, these innovations are designed to make your life easier when restoring molar teeth. Full references for this article are available online at: Nobel Biocare Services AG P.O. Box 8058 Zurich-Airport, Switzerland manufacturer news 40 CAD/CAM 2 2016 The Omnigrip Screwdriver is designed for a strong grip on the screw in order to limit the risk of it detaching in the patient’s mouth (see also cover image). The NobelProcera FCZ Implant Crown combines full-contour strength with restorative flexibility, whichever of the eight shades you choose. 22016

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