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PUBLISHED IN DUBAI www.dental-tribune.me March-April 2017 | No. 2, Vol. 7 Technology meets craftsmanship By Dr Dario Žujic, DT Velimir Žujic, Croatia, and DT Dragan Stolica, Slo- venia Many edentulous patients wish to have their oral functions re-estab- lished with a fixed esthetic restora- tion. We can meet this request by combining implantology with den- tal CAD/CAM technology. implant-supported Full-arch su- perstructures can be achieved by various methods. Depending on the bone quality and number of implants, the patient may either re- ceive a fixed or removable implant restoration. If a fixed prosthesis is indicated, the superstructure may either be cemented or, alternatively, screwed directly to the implant fix- ture, depending on the clinical situ- ation. In the case described here, we opted for a cemented zirconium ox- ide bridge. Monolithic crowns were used in the posterior region. For the anterior region, the crowns were cut back and veneered. Translucent zir- conium oxide (Zenostar® T, Wieland Dental) was utilized for the frame- work and IPS® e.max Ceram for the veneering of the anteriors. These ma- terials allowed the desired strength and esthetics to be achieved. Preoperative situation When the patient came to our den- tal lab, she wore a classic full-arch denture in her upper jaw. She was unhappy about the esthetic ap- pearance, functional qualities and the loose fit of the denture. Her oral condition was assessed with digital volume tomography (DVT) to con- firm that adequate bone quantity was available to facilitate the anchor- age of the implants. Although the placement of four implants would have provided adequate stabil- ity for a removable denture, the patient desired a fixed all-ceramic reconstruction. Having discussed the treatment options with her, we abandoned the idea of providing an implant-supported denture based on the “All-on-4” concept and instead chose to manufacture a fixed, implant-retained bridge. The frame- work would be made of zirconium oxide and the anterior teeth would be individually veneered. Fig. 1: The seven implants in the edentulous jaw were to be connected to a fixed bridge made of zirconium oxide Implant treatment and healing phase On the basis of the DVT examina- tion, seven implants (Replace CC, Nobel Biocare) were planned and placed. An adequate primary stabili- ty of 30 to 35 Ncm was achieved. Dur- ing the healing phase, the patient wore the existing denture that had been relined with soft silicone. After a six-month healing period, a satis- factory level of osseointegration was achieved, without any signs of bone resorption or inflammation. The im- plants were uncovered and gingiva formers inserted. Two weeks later, an impression was taken to transfer the position of the implants to the den- tal lab. After model fabrication, ap- propriate abutments were selected and adapted to achieve a common insert direction for the bridge (Fig. 1). Digital technology was employed to manufacture the temporary bridge. The model was scanned using a Ze- notec® D800 lab scanner (Wieland Dental) and the temporary bridge designed with the 3shape dental design software. Milling was carried out in a Zenotec select S2 milling unit (Wieland Dental) using a PMMA ma- terial (Telio® CAD). Framework fabrication As the patient was satisfied with the shape and function of the temporary ÿPage B2 Figs 2a and b: Digitized model with temporary restorations (above) and abutments (below) LIFELIKE ESTHETICS – EFFICIENTLY PRESSED IPS e.max® PRESS MULTI THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT • Monolithic LS2 restorations showing a lifelike shade progression • Exceptional combination of strength, esthetics and effi ciency • For crowns, veneers and hybrid abutment crowns • Coordinated with high-precision Programat press furnaces • Maximum cost effectiveness in the press technique c e r a m i c y o u n e e d l l a l a l www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstrasse 2 | 9494 Schaan | Liechtenstein Tel.: +423 235 35 35 | Fax: +423 235 33 60