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

| case report digital workflow 28 CAD/CAM 4 2016 lus was debrided with manual and ultrasonic in- strumentation. Itwasthenconditionedwithdoxycyclineforabout 3 minutes, followed by sterile saline irrigation. Palatal positioning of an OsseoSpeed EV 4.2C x 13.0 mm implant was performed. The OsseoSpeed EV implant has been shown to be significantly strongerthanitspredecessor(OsseoSpeedTX).20 In a prospective multi-centre study, Stanford, et al21 demonstrated that the Astra Tech Implant System EV performed equally as compared to the pre- vious product lines within the Astra Tech Implant SystemTXregardingradiographicbonelevels,with a subjective sense of greater stability at time of placement. Obturation of the void between the implant and the socket walls was accomplished with a mixture of approximately 3:1 freeze-dried bone allograft (FDBA) and deproteinized bovine bone mineral (DBBM). A 4.2 Implant Pick-Up EV impression post was tightened and the facial flap repositioned with temporary sutures to protect the underlying tissues during a surgical impression. The impression was poured with an implant re- plica in place to facilitate provisionalization at the restorative dentist’s office immediately after surgery. The site was then reopened and the same bone graftwasplacedoverthefacialcortexandcovered with a dermal allograft (Symbios PerioDerm GBR), which was adapted via a tissue punch around a HealDesign EV healing abutment. Symbios Perio- DermGBRwasselectedasthedesiredmaterialdue to its structural integrity, closely resembling that of human tissue. Viable cells and antigens are re- moved without damaging the remaining matrix, which serves as a framework for cellular infiltra- tion and vascularization. The flap was then sutured securely around the healing abutment with resorbable sutures. The patient was prescribed amoxicillin 500 mg for ten days, a six-day course of methylprednisolone (Medrol Dosepak), Etodolac 400 mg for analgesia and Chlorhexidine Gluconate rinses bid. He was instructed to avoid all mastication in the anterior dentition for at least six weeks. Immediately after surgery, the patient reported to his restorative dentist’s office for fabrication and deliveryofascrew-retained,provisionalrestoration. A temporary abutment (Temp Abutment EV 4.2) was modified and covered with opaque composite resin prior to addition of bis acryl and flowable composite resin. It was contoured and polished andthefacial/incisalscrewaccesschannelcovered with Teflon tape then flowable composite resin. Thisrestorationwastorquedto15Ncmandplaced out of occlusal contact with the opposing man- dibular teeth, and light contact with the adjacent teeth. The patient was seen for post-operative appoint- ments at ten days and again at eight weeks at the Fig. 14: Radiograph two months post-op. Fig. 15: Healthy peri-implant soft tissue after removal of the provisional crown. Fig. 16: Atlantis IO FLO scan body placed for digital impression Fig. 17: Digital model with Atlantis IO FLO scan body. Fig. 18: Patient-specific Atlantis Abutment in zirconia. Fig. 19: The unique interface design of the Astra Tech Implant System EV allows for one-position-only placement of Atlantis patient-specific abutments. Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 42016

Pages Overview