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

implant-supported restoration case report | 25 CAD/CAM 4 2016 first (Fig. 9). Next, translucent, light-curing gingival materials (SR Nexco Paste Gingiva and SR Nexco Paste Basic Gingiva) were used to impart the gingi- valareaswiththedesireddepth(Fig.10).Thecolours of the Gingiva composites range from pale pink through reddish and orange to purple. A certain amount of time and effort are necessary to master thenecessarymixingtechniquesandachieveahar- monious interplay of the intensive and the trans- lucent materials. Practical experience is essential. With some technical skill, the gingival areas can be naturallyreproducedintermsofshape,textureand shade. All the individual layers were pre-cured (Quick curing light, Ivoclar Vivadent) in segments. A high- performance curing light was used for the final polymerization. Prior to this step, a coating of glycerine gel (SR Gel, Ivoclar Vivadent) was applied to the surfaces to prevent oxygen inhibition, which could lead to an unattractive result that is difficult to polish. The surfaces of the teeth were character- ized with a vertical and horizontal macrostructure. Particular attention was paid to mechanical polish- ing. Once the glycerine gel had been removed, the restorations were finished with different polishing instruments (various grit sizes, pumice, leather buffing wheels and universal polishing paste; Fig. 11). In the present case, mechanical polishing was preferred to glazing with a light-curing com- posite in order to prevent premature ageing of the surface. Thedentureswereseatedmanuallywiththehelpof multi-unit abutments from Nobel Biocare (Fig. 12). The screw channels were sealed with Teflon and light-curing composite resin. The position of maxi- mum intercuspation was checked and the occlusal pathways were adjusted to the protrusive and lat- erotrusivemovements.Inaddition,therestorations were checked in terms of the ability to clean them with interdental brushes, and the patient was given special instructions regarding her oral hygiene. Conclusion For a long time, ceramics were considered to be the aesthetic benchmark. With the introduction of state-of-the-art industrially fabricated acrylic teeth specially designed for implant applications, the bar for aesthetics has been raised in this cate- gory of materials. The teeth used in this case exhibit atrue-to-naturemorphology,whichallowstheres- toration to be functionally integrated without any problems.UsingthelaboratorycompositeSRNexco torecreategingivaltissueisaneffectiverestorative approach. In contrast to ceramic materials, the composite resin is easy to handle and delivers exceptionally aesthetic results (Fig. 13). The light weight of the material is an added benefit. An all- ceramic restoration (zirconium dioxide framework, layering ceramic, gingival mask) weighs almost twice as much as a titanium and composite resin denture. Another advantage of the type of resto- rationdescribedhereisitslongservicelife.Thesuc- cess of an implant-supported denture depends on the systematic coordination of all the surgical and prostheticrequirements.Astrictprocedureneedsto be followed from the treatment plan to the final outcome. Layering gingival portions with a labora- tory composite represents a genuine improvement on previous materials and methods with regard to aesthetics, handling and hygiene (Fig. 14)._ contact Dr Patrice Margossian maintains a private practice specializing in implantology and prosthetics in Marseille in France. He can be contacted at pm@patricemargossian.com. Dr Andrieu Pierre is a practising prosthodontist in Aix-en-Provence in France. He can be contacted at andrieupi@wanadoo.fr. Fig. 14: The complex restoration gave the patient a new lease on life. Fig. 14 42016

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