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

implant-supported restoration case report | 23 CAD/CAM 4 2016 performed on one day. At the same time, four mandibular implants were placed and loaded. An immediate denture was seated in the upper jaw. During the osseointegration period of the man- dibular implants, the maxillary bone was recon- structed. The maxillary sinus and the alveolar ridge were augmented in one appointment. At a later appointment, ten implants were placed according to the treatment plan and exposed after six more months. As a result of well-planned soft-tissue management, adequate firm keratinised tissue had formed. The permanent restorations for the upper and lower jaws were fabricated two months later (Figs. 3 & 4). The determination of the occlusal plane and the ideal incisal line allows the dental arches to be integrated more easily in terms of aesthetics and function. Open-tray impressions were taken with a special plaster (Snow White, Kerr Dental) and unsplintedimpressionposts.Theconsiderablestiff- ness of the impression material completely immo- bilisedtheimpressionposts,therebypreventingany errors in the casting of the study models. An articulator allows the kinematics of the jaw to be correctly simulated. The goal of this part of the treatment is of a functional nature. It is intended to ensure optimal occlusal integration of the resto- rationsandtheproperjawmovementsduringmas- tication,speakingandswallowing.Inthisparticular case, the maxillary model was positioned with the help of a facebow. Four impression posts were screwed on to the implants in order to provide strong support and enhanced reliability. Alternatively, this step can take place directly on the immediately loaded provisional restorations. For this purpose, however, the model has to be mounted in the articulator. In the present case, the masticatory model was positioned in correct rela- tion to the hinge axis-orbital plane. Subsequently, we adjusted the bite patterns in order to record the vertical dimension of occlusion. The centric relation is regarded as the reference position for adjusting the muscles to the centric and functional jaw relation. The mandibular model was mounted in the articulator with the help of an antagonistjawrelationrecord.Ifthecentricrelation and the vertical dimension of occlusion are correct, the immediately loaded provisional restorations can be used for this purpose. The restorations have to be immobilised when they are mounted in the Fig. 4: Four implants were placed in the lower jaw. Bone augmentation measures were not necessary in this case. Figs. 5a & b: Recording of the aesthetic facial axes with the Ditramax system. Fig. 6: The denture was set up with prefabricated teeth (SR Phonares II). Fig. 7: Try-in of the CAD/CAM-fabricated titanium framework in the upper jaw. Fig. 4 Fig. 5a Fig. 5b Fig. 6 Fig. 7 42016

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