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Dental Tribune Middle East & Africa Edition | 4/2016 lab tribune2 ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Join the largest educational network in dentistry! www.DTStudyClub.com – education everywhere and anytime – live and interactive webinars – more than 1,000 archived courses – a focused discussion forum – free membership – no travel costs – no time away from the practice – interaction with colleagues and experts across the globe – a growing database of scientific articles and case reports – ADA CERP-recognized credit administration register for FREE Dental Tribune Study Club ◊Page1 the anterior region, the location of the screw opening can impair the esthetical appearance of the final result. The other challenge, which this case posed, was to create an es- thetical, screw-retained restoration, despite the diverging implant posi- tions. There was only one solution to achieve satisfactory esthetics: Multi-unit elements in the posteri- or region and “no-Hex” abutments (conical cementation) for the im- plants in the anterior region (Fig. 3). The plan comprised placing a zirconium oxide secondary frame- work over the top of the prepared substructure in the anterior region. An acrylic guide was made so that the “no-Hex” abutments could be transferred and inserted into the mouth precisely. Amongst other things, the wax-up was used as a guide for the estheti- cal design. The wax-up was digital- ized together with the model and the abutments in the laboratory scanner. The data for the framework con- struction was imported to the CAD software.Theframeworkwasmilled fromazirconiumoxidedisc(Fig.4a) and then sintered at 1,500°C. The thread hole, for screw-retention of the secondary structure, was drilled with a special thread cutter into the material whilst in a half sintered state (Fig. 4b). In order to check our progress and determine the next steps, the zirconium oxide frame- work was checked and the wax-up was transferred to the anterior re- gion. For this we used the light-cure laboratory composite SR Nexco®. Minimal differences to the wax-up were corrected by the dentist in the practice (Fig. 5). After sintering, the zirconium oxide framework was slightly trimmed. Next a regeneration bake was carried out. The prosthetic gin- giva was completed with SR Nexco Paste Gingiva composite. Mechani- cal retention is necessary in order to achieve an ideal bond with the zirconium oxide framework. This was achieved with an applica- tion of glaze material, then sand- blasting with Al2O3 (Fig. 6). The manufacturer recommends the use of SR Link. After trimming, the zir- conium framework was sandblast- ed with Al2O3 in order to improve the mechanical retention. This was then simply knocked off and the metal composite bonder SR Link was applied immediately thereaf- ter with a clean, disposable brush. The areas to be over-pressed with the fluor-apatite glassceramic IPS e.max® ZirPress were covered with IPS e.max Ceram Zirliner. After this, a ZirLiner bake was carried out (Fig. 7). On the one hand, the IPS e.max Ceram ZirLiner is used to create a good bond between the framework and the over-press ceramic. On Fig. 7:The framework was covered with IPS e.max ZirLiner in the poste- rior teethregion. Fig.10:Aftercompletionof theprostheticgingivaand thefinalrestoration Fig.8:Thewaxcrownswereadapted to theframework... Fig. 9: ... and reproduced in ceramic using the press technique. Then the anterior teethand thegingivalareaswerebuilt-upindividually. ÿPage 3 Fig.11:Therestorationbefore theanterior teethwerefixed