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

CAD/CAM 4 2016 treatment planning based on CBCT cone beam supplement | 45 were bone profiled prior to SRA abutment place- ment. This allowed the complete seating of the SRA abutment at the recommended 35 Ncm torque. Using the available Straumann® bone profilers with the appropriate Narrow Connection (NC) or Regular Connection (RC) inserts was a critical step for an abutment to fit correctly. The following SRA abut- ments (all were 2.5 mm gingival heights) were then chosen:straight:FDI:#32,#42/US:#23,#26;17de- grees: FDI: #15, #12, #11, #21/US: #4, #7, #8–9; and 30 degrees: FDI: #23, #25, #34, and #44/US: #11, #13, #21, and #28. Tall protective healing caps were then placed (Fig. 8), and the dentures were checked to evaluate that there was adequate space for the pink acrylic to allow for bite registration material thickness. All sockets and buccal gaps to the imme- diately placed implants were bone grafted. Prior to suturing, the tissue flaps were scalloped with 15c bladestoreduceoverlapoftheflapsovertheprotec- tivecaps.Thisnotonlyaidedinpost-operativeheal- ing, but also aided in the visualisation of the abut- ments by the restorative dentist for the provisional insertion. The patient was sutured with resorbable 4-0 chromic gut and 5-0 Vicryl™ sutures (Ethicon: Johnson & Johnson) and was released to be seen immediately by Dr Randel for the coordinated re- storative visit. As discussed below, his responsibilities included: bite registration, impressions, and the dental lab conversion of the complete denture to a metal- reinforcedfixedtransitionalprosthesis(indirectpro- visionalisation technique). Our team of restorative dentists have been treating full-arch immediately loaded cases on 5–8 implants (depending if resto- ration is a hybrid or C&B) since 1994. Our earlier experiences, for approximately the first two years (1994–1996), have resulted in us all presently using theindirecttechnique,whichinourhandsiseasierfor everyoneinvolved(especiallythepatient).Wehandle these coordinated visits between offices, the dental lab, and our Straumann representative weeks in ad- vance so we are all on the same page with timing. These coordinated efforts could be compared to a symphony orchestra, where each musician knows their specific part and when and where they are ex- pected to be. Many of our patients have described this fluidity as a seamless experience that they wit- ness first hand and greatly appreciate. Same-day restorative appointment The patient was seen in Dr Robert Levine’s office forrestorativerecordswithDrRandel(prosthodon- tist)inpreparationforimmediateloadprotocol.The previously processed dentures were first checked with pressure paste to ensure the absence of con- tact between the intaglio surface and the tall heal- ingcaps.Biteregistrationmaterialwasthenusedto confirm there was no contact (Fig. 9), and later will be used by the lab to articulate the models. Efforts were made to confirm the OVD (with the marked tongue depressor provided by Dr Levine), incisal position, midline, plane of occlusion, and centric position with the prosthesis in place. Adjustments were made as needed. Photographs were acquired todocumentandrelayinformationviae-mailtothe lab technician. The lab will use the registration ma- terial left in the intaglio surface of the prostheses, as healing caps will be placed on the newly fabri- cated models. This allows the index to transfer the OVD and centric relationships with contact just on the healing caps. The soft tissue plays no role in this relationship.Abiteregistrationwasmadetoconfirm centric relation. Healing caps were then removed and open tray impression copings were placed. If the connection between the implant abutments and the impression copings are not visualised, then X-ray confirmation of the connection is needed. Transferimpressionsweremadeusingacustomtray and rigid impression material of choice, in this case polyether was used. Fig. 10 Fig. 11 Fig. 12 Fig. 10: Insertion of the prostheses. Fig. 11: Panoramic radiographic confirmation of proper seating. Fig. 12: GC verification jigs. 42016

Pages Overview