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ePaper created 2017-12-06, 12:03:50 | version 1.38.0
serted in a primary stable manner with a torque of between 30 to 45 Ncm (Fig. 9). The abutments were applied and the area sutured. The pre-fabricated tem- porary restoration was inserted without an impres- sion needed. The palate provided support in order to ensure the reliable referencing of the mouth. The tem- porary restoration was bonded with the abutment for a tension-free intraoral fit (Qu-resin, bredent medical), lined and the bridge was then processed and produced (Figs. 10 & 11). Manufacture of the final restoration The postoperative progress was free of problems. The patient was able to participate in social activities without restriction during the healing phase. Osseo- integrated implants and stable hard- and soft-tissue conditions were seen after three months. Following a pick-up impression, the temporary restoration was removed and the implant situations were modelled using an individual tray (Figs. 12–14). A screwed res- toration was also planned for the final dental prosthe- sis. The framework made from non-precious-metal alloy (NEM) should be veneered using a high-quality composite material. In order to give the aesthetic design ample space, transverse screwing (bolting) of the dental prosthesis with the implants was consid- ered. In principle, a restoration screwed onto implants places a high demand on the framework fit. In com- plex restorations of this type, this involves a consid- erable challenge in the production procedure. Due to the implant’s rigid bond with the bone, even a low amount of force can cause considerable dis- placement of the implants. The highest level of precision is required from both the dentist and the dental technician. Digital manu- facturing technologies come into play here. These of- fer a perfect framework fit and a high material quality —the icing on the cake is that production is also effi- cient. In the CAD software, the data relating to the pick-up impression is superimposed on the data relat- ing to the implant master model (matching) and a framework is constructed in a smaller anatomical crown shape. In the software, the bonding elements for the transverse bolting were integrated in the framework (Figs. 15–17). CAM milling of the NEM framework was carried out in the laboratory’s own high-performance milling machine. The thread for the transverse bolting was then incorporated within the cavity incorporated in the bridge framework (Fig. 18). A framework try-in in the mouth confirmed that this was the perfect fit. The individual veneering of the restoration was carried out using pre-fabricated ve- neers (novo.lign, bredent medical). The veneers were fixed to the framework with a dual-hardening adhe- sive and the individual fine touches were added with a veneer plastic (crea.lign, bredent medical). The Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 industry | Figs. 12–14: The implant model for manufacturing the final restoration (transverse screwed bridge). Fig. 15: CAD construction with the bonding elements for the transverse bolting. Fig. 16: Digitalised set-up. Fig. 17: Construction of the framework in a smaller, anatomical crown shape. implants 4 2017 35