Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-10-04, 09:33:57 | version 1.38.0
| ce article aesthetic replacement of maxillary premolar 22 CAD/CAM 3 2016 Thepatientreturnedtotherestorativeofficeforeval- uation and to develop necessary records for the lab- oratory fabrication of the definitive restoration. The implant site was evaluated and deemed adequately healedtoproceedwithrestorativeprocedures(Fig.6). Thehealingabutmentwasremovedandaclosedtray impressioncopingwasfittedontotheimplant(Fig.7). A radiograph was taken to confirm complete seating of the impression coping. A full-arch impression was taken with heavy body PVS impression material (PanasilTraySoft,HeavyBodyRegularSet,Kettenbach) (Fig. 8). The healing abutment was replaced once im- pression was taken. A bite registration (Futar D Fast Set Kettenbach), new opposing impression (Silginate plus Panasil Light Body Fast Set, Kettenbach) and shademapweretaken.Allclinicalproductsweresent to the laboratory along with shade photography and a complete written prescription. APFMhighnoblecrownandAtlantisgoldhuecustom abutmentwereprescribed.Theabutmentwasordered as tissue contouring with 1 mm deep margin place- mentcircumferentially(Atlantis,DENTSPLYImplants). Theuseofacustomabutmentallowsmodificationof thetransmucosaltissueprofileandtoideallyposition margins. Tissues were previously shaped with the ovateponticofthetemporarypartial.Thefinalcrown was planned to be chairside custom stained. The lab wascautionedthatocclusiononthisrestorationwas in the path of the patient’s cross bite transition from normal to cross bite. The laboratory (Drake Precision Dental Laboratories) partnered with Atlantis for the abutment design and milling and then fabricated the PFM crown (Figs. 9 & 10). An appointment was made for the patient to come and have the definitive restoration placed. The appointment was uneventful. The healing abut- ment was removed and the Atlantis abutment was placed (Fig. 11). Due to positive tissue pressure from the tissue contouring, the abutment was slowly placedwithincrementalturnsoftheretentionscrew. Tissue blanching was carefully observed. The abut- ment was fully seated and within five minutes, tissue blanching had disappeared. The Atlantis abutment was torqued to the manufacturer’s specifications (30Ncm).Aradiographwastakentoconfirmthefinal seating of the abutment. The PFM crown was tried on and interproximal con- tactsadjustedtoallowcompleteseatingofthecrown. Occlusion was marked with appropriate articulation ribbonandadjustmentswereaccomplished,withpar- ticular attention to functional path and centric con- tacts.Thefinalocclusionrespectedthecrossbitewhile providingalightocclusalcontactthatbecamenormal in intensity upon biting.2 All functional contact was adjusted to be in minimal contact during excursions. Adjacent teeth provided partial group function. Once all clinical adjustments were done, a laboratory technician was consulted for the final shade match- ing.Theinitialshadewasveryclosetoideal.Thetech- Fig. 10: Gold hue Atlantis abutment (DENTSPLY Implants) on analogue model. Fig. 11: Gold hue Atlantis abutment (DENTSPLY Implants) in place. Fig. 12: Cementation jig. Fig. 13: Final patient lateral smile. Fig. 10 Fig. 11 Fig. 12 Fig. 13 32016