CAD/CAM international magazine of digital dentistry No. 4, 2016

full mouth restoration case report | 19 CAD/CAM 4 2016 guidewasseatedoverthepatient’smaxilla,andthe fixationpinsweretightened(Fig.4).Tissuepunches were used to provide access to the preplanned implant sites. The implant osteotomies were cre- ated following the simplified surgical protocol of the Hahn Tapered Implant System (Figs. 5a & b). Eightimplantswereplacedfromfirstmolartofirst molar in the maxillary arch (Figs. 6a & b). Healing abutmentswereconnectedtotheimplantstohelp prepare the soft tissue for the restorative phase (Fig. 7). Next, the patient’s untreatable mandibular teeth were extracted, a flap was reflected, and alveo- plasty was performed (Fig. 8). A bone-supported guide was seated in order to control the location andangulationoftheimplantosteotomies(Fig.9). As the Hahn Tapered Implants were threaded into place, their deep, sharp threads engaged the walls of the socket sites and helped maintain proper position toward the lingual aspect (Figs. 10a & b). Because of anticipated tissue swelling as a result ofthebone-levelingprocedure,5-mm-tallhealing abutments were connected to the implants in the lower arch (Fig. 11). The immediate dentures were soft-relinedtoseatovertheHahnTaperedImplant Healing Abutments, the hourglass shape and un- dercuts of which provided a degree of retention that enhanced dental function for the patient during healing. Four months later, the healing abutments were removedandthestabilityoftheimplantswascon- firmed (Fig. 12). Hahn Tapered Implant Impression Copings were seated with ease due to their con- toured cervical area, which matches that of the healing abutment (Figs. 13a & b). Closed-tray im- pressions were taken, as well as a bite registration with the patient’s immediate dentures in place. Because the immediate dentures were well-fitting and satisfactory to the patient, duplicates were provided to the lab to aid the restoration design process. Based on the impressions, the lab poured and scanned stone models, creating a digital rep- resentation of the patient’s arches on which the designsforcustomabutmentsandthecementable Figs. 14a & b: Advanced dental CAD software was used to design the custom abutments and the cementable FP3 prostheses, which included gingival areas in order to recreate the bone and soft-tissue contours. Figs. 15a & b: The PMMA try-in bridge and temporary restoration were milled based on the initial digital prosthetic design. Gingival stain was applied to the temporary appliance so it could function as an esthetic provisional. Fig. 16: Acrylic delivery jigs were used to seat and confirm proper orientation of the Inclusive Custom Titanium Abutments. Fig. 17: The custom abutments adhered closely to the tissue anatomy of the implant sites, establishing margins at or near the gingival surface. Fig. 18: The digitally fabricated PMMA try-in appliances were seated over the custom abutments, evaluated and modified to ensure proper fit, function, occlusion and esthetics. Fig. 16 Fig. 17 Fig. 18 Fig. 14a Fig. 14b Fig. 15a Fig. 15b 42016

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