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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
| CE article aesthetic replacement of premolar Fig. 10: Gold hue Atlantis abutment on analogue model. Fig. 11: Gold hue Atlantis abutment in place. Fig. 10 Fig. 11 The patient attended the restorative office for eval- uation and to develop necessary records for labora- tory fabrication of the definitive restoration. The im- plant site was evaluated and deemed adequately healed to proceed with restorative procedures (Fig. 6). The healing abutment was removed and a closed tray impression coping was fitted onto the implant (Fig. 7). A radiograph was taken to confirm complete seating of the impression coping. A full-arch impression was taken with heavy body PVS impression material (Panasil tray Soft, Heavy Body Regular Set, Kettenbach) (Fig. 8). The healing abutment was replaced once the im- pression was taken. A bite registration (Futar D Fast Set, Kettenbach), new opposing impression (Silginate plus Panasil Light Body Fast Set, Kettenbach) and shade map were taken. All clinical products were sent to the laboratory along with shade photography and a complete written prescription. A PFM high noble crown and Atlantis gold hue custom abutment were prescribed. The abutment was ordered as tissue con- touring with 1 mm deep margin placement circum- ferentially (Atlantis, Dentsply Sirona). The use of a custom abutment allows modification of transmucosal tissue profile and to ideally position margins. Tissues were previously shaped with the ovate pontic of the temporary partial. The final crown was planned to be chairside custom stained. The lab was cautioned that occlusion on this restoration was in the path of patient’s crossbite transition from nor- mal to crossbite. The laboratory (Drake Precision Dental Laborato- ries, Charlotte, NC) partnered with Atlantis (Dentsply Sirona) for the abutment design and milling and then fabricated the PFM crown (Figs. 9 & 10). The patient was given an appointment for definitive restoration delivery. The delivery appointment was uneventful. The healing abutment was removed and the Atlantis abutment was placed (Fig. 11). Because of positive tissue pressure from tissue contouring, the abut- ment was slowly placed with incremental turns of the retention screw. Tissue blanching was carefully observed. The abutment was fully seated and, within five minutes, tissue blanching had disappeared. The Atlantis abutment was torqued to manufacturer’s specifications (30 Ncm). A radiograph was taken to confirm final seating of the abutment. The PFM crown was tried on and interproximal contacts adjusted to allow complete seating of the crown. Occlusion was marked with appropriate ar- ticulation ribbon and adjustments were accom- plished, with particular attention to functional path and centric contacts. The final occlusion respected the crossbite while providing a light occlusal contact that became normal in intensity upon biting force.2 All functional contact was adjusted to be in minimal contact during excur- sions. Adjacent teeth provided partial group function. Fig. 12: Cementation jig. Fig. 13: Final patient lateral smile. Fig. 12 Fig. 13 34 CAD/CAM 2 2017