Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-09-11, 09:00:39 | version 1.38.0
10 TRENDS & APPLICATIONS Dental Tribune Asia Pacific Edition | 9/2017 A convincing duo: Zirconium dioxide and fluorapatite glass-ceramic The symbiosis of different procedures and materials for simplified and safe outcomes 1 3a 5a 5b By Dr Torsten Seidenstricker & Dominique Vincix Switzerland This patient case demonstrates how a monolithic zirconium diox- ide framework can ensure stability and function in a complex pros- thetic restoration. The ceramic ve- neering of the vestibular surfaces gives the restoration natural light optical propertiesx contributing to the very pleasing final results. Initial situation A 60-year-old patient came to the dental practice as an emer- gency case. In addition to aes- thetic and functional problems, there was severe periodontal damage. The treatment began with an in-depth diagnosis and an informative consultation. First, teeth #25, 26, 14, 16, 11 and 12 were extracted. The periodontitis was then targeted. Treatment of the periodontitis was successfully com- pleted approximately 13 months later. Implants needed to be placed in regions #11, 12, 14, 16, 25 and 26. The clinical situation meant that all teeth in the maxilla and some teeth in the mandible had to be restored. 2 3b 4 Fig. 1: The situation after the implants in the maxilla had healed. All-ceramic restorations were planned.—Fig. 2: Diag- nosis according to photographs in the design software.—Figs. 3a & b: The master model with the gingival mask in the articulator. —Fig. 4: The upper wax-up in the planned final situation. —Figs. 5a & b: CAD construction of the abutments. Planning and tempo- risation Before starting such an ex- tensive prosthetic reconstruc- tion, photographic documenta- tion of the oral situation and the patient’s face is essential. Pri- marily, the photographs help in assessing the axes and planes in terms of optimum aesthetics and function. We work with a 3-D design program (Digital Smile System, DSS). This tool enables us to simulate the possible re- sults virtually. Another advan- tage of this software is that the photographs can be used in the CAD software while the restora- tion is being produced. The teeth to be extracted were removed from the situation model, and the remaining teeth were pre- pared using the information provided by the dentist. On this foundation, we de- signed a wax-up with the CAD software (3Shape) and then transferred it to wax. This was the basis for a matrix made from transparent silicone, which was sent to the practice. After the dental preparation was complete (implant placement, preparation, etc.), the matrix was filled with an auto-polymerising tempo- rary composite (Telio CS C&B, Ivoclar Vivadent) and a tempo- rary restoration was produced and then inserted into the mouth. The temporary restora- tion served as a dental prosthesis during the implant healing phase, and it allowed us to deter- mine whether the situation, which was planned in the laboratory, harmonised in a functional and aesthetic manner in the patient’s mouth. The patient wore the adapted temporary restoration for approximately six months up to the osseointegration of the implants. Production of the final dental restoration Implant abutments The wax-up was positioned on the master model and adapted based on the patient’s and den- tist’s feedback. A double scan fol- lowed. We digitised both the model and the wax-up using the laboratory scanner. Subsequently, the implant abutments were pro- duced via CAD/CAM. The im- plant abutments were milled from a new translucent zirco- nium dioxide material (IPS e.max ZirCAD, Ivoclar Vivadent). Before sintering, we stained the cervical areas of the frameworks. We used a liquid with a warm yellow tone for the infiltration. After sintering, the implant abutments were adhesively bonded to the titanium bases (TiBase, Straumann) with a lut- ing composite (Multilink Hybrid Abutment, Shade HO, Ivoclar Vivadent) specifically designed for this indication. The self-cur- ing composite provides excellent adhesion qualities. After adhesive bonding, the abutments were in- tegrated. Production of the framework The following restorations were planned for the final pros- thetic restoration: 1. a bridge in regions #11–13; 2. a bridge in regions #14–16; 3. a crown on tooth #17; 4. seven single crowns on teeth #21–24 and 27, as well as in regions #25 and 26. 6 7a 7b Fig. 6: The CAD/CAM-fabricated abutments (hybrid abutments) were screwed on to the implants.—Figs. 7a & b: The CAD framework construction after the buccal areas had been cut back.