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ePaper created 2018-02-16, 10:54:19 | version 1.38.0
| case report implant-supported restoration Fig. 8 Fig. 9 Fig. 10 Fig. 8: The ground-down composite resin areas were conditioned for receiving the light-curing laboratory composite SR Nexco. Fig. 9: Application of the colour- saturated intensive gingiva materials (SR Nexco Paste Intensive Gingiva). Fig. 10: The application of various translucent materials imparted the prosthetic gingiva with the desired depth effects. Fig. 11: Lifelike, vital, aesthetic— the white and pink aesthetics were optimally imitated. Fig. 12: The restorations on the implants in the upper and lower jaws. Fig. 13: Close-up view: the macro- and microstructure of the teeth and the characteristic play of colour of the gingiva is clearly visible. articulator. The Artex system (Amann Girrbach) allows the articulator of the dental practice and that of the laboratory to be synchronised. The Ditramax system was used to transfer the pre- cise data on the aesthetic facial axes to the maxillary model (Figs. 5a & b). Two axes were marked on the plaster base of the model (vertical and horizontal). The vertical axis represents the midsagittal plane. From the front, the horizontal axis is aligned paral- lel to the interpupillary line and from the side to Camper’s plane. These markings, which should be very close to the working area, function as a guide for the dental technician in setting up the teeth. Therefore, the incisal line has a predictable parallel alignment with the interpupillary line. The incisal axis is aligned parallel with the midsagittal plane. The Camper’s plane markings indicate the alignment of the occlusal plane. All these elements provide a sound rationale for the tooth set-up according to aesthetic and functional principles. We selected the tooth shade and the teeth on the basis of the SR Phonares II tooth mould chart (Ivoclar Vivadent). Holding the teeth up against the lips of the patient quickly revealed whether they were in harmony with her facial features. The set-up of the teeth according to the Ditramax markings (Fig. 6) allows the situation to be clinically validated. In this case, attention was given in particular to the aesthetic integration of the dentogingival complex when the patient was smiling. The lip dynamics were shown with video clips. The functional criteria were also checked. The vertical dimension of occlusion had to be harmonious in order to achieve a balanced lower facial third and proper phonation. We felt that a CAD/CAM-fabricated titanium frame- work (NobelProcera, Nobel Biocare) would best fulfil this indication. The double-scan technique allowed the implant model to be superimposed on the tooth set-up to construct the framework. In the next step, the framework was machined and then tried on the model and in the patient’s mouth (Fig. 7). The cast impression and the high-performance processing systems significantly contributed to providing the optimal passive (tension-free) fit of the framework, which is decisive for the long-term success of the restoration. The areas that needed to be built-up with gingival materials were blasted with aluminium oxide at 200 to 300 kPa pressure. Subsequently, the SR Link bonding agent (Ivoclar Vivadent) was applied, fol- lowed by a thin layer of the light-curing SR Nexco Gingiva Opaquer to mask the metal framework. The Opaquer was polymerised and then a second coating was applied and polymerised. The resulting inhibition layer was removed. The conventional flask technique with a heat- curing denture base material (ProBase Hot, Ivoclar Vivadent) was used to produce the denture. After the polymerisation process, the denture base was ground and space was made for building up the Gingiva composite. The surface was conditioned by blasting it with aluminium oxide (50 µm) at 200 kPa (Fig. 8). A bonding agent was then applied and left to react for three minutes before it was light cured. In order to achieve very lifelike results in the layering of the gingival tissue, saturated (intensive) materi- als (SR Nexco Paste Intensive Gingiva) were used Fig. 11 34 Fig. 12 Fig. 13 cosmeticdentistry 1 2017