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

| case report full mouth restoration 20 CAD/CAM 4 2016 restoration were created (Figs. 14a & b). Note that althoughtheimpressions,biteregistrationandim- mediate dentures were sufficient for establishing the initial prosthetic design for this patient, the dental lab requires a wax rim and setup try-in in most cases in order to establish the correct centric relation,verticaldimension,interocclusalrelation- ship and other details. Inclusive Titanium Custom Abutments (Glidewell Europe GmbH) were fabri- cated, and a try-in bridge and a BioTemps restora- tion (Glidewell Europe GmbH) were milled from solid blocks of PMMA (Figs. 15a & b). The patient returned for clinical evaluation of the prosthetic design. The custom abutments were delivered using lab-provided acrylic delivery jigs, which helped ensure proper orientation during seating (Fig. 16). Due to the precision of the digital design process, the fit of the custom abutments was ideal, establishing margins that were at or a slight distance from the gingival surface (Fig. 17). This simplified the removal of excess cement from themarginsandillustratestheadvantagesofCAD/ CAM-produced abutments. ThePMMAtry-inbridgeswereseatedoverthecus- tom abutments, and slight alterations were made to fine-tune the gingival margins, length of teeth, and bite (Fig. 18). The same adjustments were then made to the BioTemps restorations. A bite regis- tration was taken with the try-in bridges in place. The provisional prostheses were affixed to the custom abutments with temporary cement, func- tioned well for the patient for the duration of healing, and helped the patient confirm that the prostheses did not present any functional or es- thetic issues (Fig. 19). The PMMA try-in bridges were returned to the lab along with photos, the bite registration and in- structions for minor modifications, including low- ering the gingival margins of the lower prosthesis and raising the gingival margins of the upper. ThelabscannedtheadjustedPMMAtry-inbridges, made the requested alterations to the prosthe- tic design, and milled the final prostheses from BruxZir Solid Zirconia. The final restoration was delivered at the next ap- pointment and established accurate fit, function and interocclusal relationship (Fig. 20). No adjust- ments were needed for the monolithic zirconia prostheses because of the PMMA try-in process, which captured the precise modifications needed for proper form and esthetics. Final radiography confirmed complete seating of the BruxZir resto- rationontheInclusiveCustomAbutments(Fig.21). The patient was extremely happy with the recon- struction of his edentulous arches, which restored esthetics,dentalfunction,comfortandconfidence (Fig. 22). Conclusion The accuracy of dental CAD/CAM technology and the versatility of prosthetic materials allow practitioners considerable flexibility in restoring theedentulousarch.Forclinicianswhopreferace- mentablesolutionorcasesinwhichboneanatomy precludes a screw-retained prosthesis, the mono- lithic zirconia restoration over custom abutments excelsinrestoringtheteethaswellasthehardand soft tissue of the fully edentulous patient._ Editorialnote:Acompletelistofreferencesareavailable fromthepublisher. contact Dr Ara Nazarian maintains a private practice in Troy, Michigan, with an emphasis on comprehensive and restorative care. Dr Nazarian is the director of the Reconstructive Dentistry Institute. He has conducted lectures and hands-on workshops on aesthetic materials and dental implants throughout the United States, Europe, New Zealand and Australia. Dr Nazarian is also the creator of the DemoDent patient education model system. He can be reached at www.aranazariandds.com. Fig. 19: Provisional BioTemps implant prostheses were also produced by the lab, delivered at the try-in appointment, and worn by the patient until delivery of the final restoration. Fig. 20: The final BruxZir prostheses, which are essentially monolithic zirconia replicas of the approved try-in appliances, were cemented over the custom abutments. Fig. 21: Final panoramic radiograph. Note the solid zirconia construction, which greatly reduces the odds of prosthetic wear, chipping and fracture. Fig. 22: The patient was extremely happy with the final outcome, which restored oral form, function and esthetics after many years of deterioration. Fig. 19 Fig. 20 Fig. 21 Fig. 22 42016

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