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Dental Tribune Middle East & Africa Edition | 6/2017 ◊Page 22 RESTORATIVE Fig. 12: Postoperative retracted view biting Fig. 13: Postoperative retracted view Fig. 14: Postoperative maxillary occlusal view Fig. 15: Postoperative mandibular occlusal view 23 taken for the definitive restorations. For both arches, impressions were taken using Instant Custom C&B Trays (Goodfit) with a heavy and light body vinylpolysiloxane im- pression material (Take 1 Advanced, Kerr). Bite relations was accomplished by picking up clear duplicates of the provisional restorations (Fig. 9). In- structions for size shape and color for the definitive restorations was forwarded to the dental laboratory and any changes indicated easily communicated to the dental labora- tory technician. A FP3 prosthesis would be fabricated for the patient’s upper and lower restorations. The pink gingival areas of this prosthesis type were needed to reconstitute the maxillary and mandibular tissue contours, as sub- stantial bone leveling was required to even out the patient’s smile. ÿPage 24 Fig. 16: Postoperative full face view. around the implants looked healthy, so the healing caps were removed and the implants evaluated. Each im- plant was tested with the Osstell ISQ (Osstell, Linthicum, Md.) implant sta- bility meter. Since the ISQ readings were all very high (above 75), impres- sion posts (Hiossen) were inserted on the multi-unit abutments. Since all the dental implants were well integrated, impressions were widths (3.5, 4.5 and 5.0 mm) of the ET III SA dental implants were used due to various widths of bone avail- able in the remaining ridge. Here, the tooth areas that would have dental implant placement included #19, 22, 23, 25, 27 and 30. A baseline ISQ reading was taken of these implants utilising the Osstell ISQ unit. Since the initial readings were all above 65 and the quality of bone after leveling was good, tem- porary Cylinders (Hiossen) were placed on the multiunit abutments (Hiossen) for immediate provision- alisation. Any residual areas around the implants or in the sockets were grafted with a putty blend of corti- cal mineralised and demineralised bone grafting material to optimise the area for regeneration. Primary closure was achieved by suturing the tissue with resorbable sutures. The immediate provisional restora- tion was tried in to insure a passive fit over the temporary abutments (Fig. 7). Once confirmed, block-out material was placed to avoid the res- toration from locking on and chair- side hard denture reline material (Rebase II, Tokuyama) placed within recesses around the temporary abut- ments to pick up the restoration. Af- ter the material completely set, the immediate provisional restoration was removed and any access mate- rial trimmed and polished with the Torque Plus (Aseptico) lab handpiece and acrylic bur (Komet). A similar series of steps was utilised for the mandibular arch. In fact, the ISQ values were even higher due to the type and quality of bone present in the patient’s mandible. At this point, a Panorex was taken to confirm the placement and position of the dental implants with their corresponding multi-unit abutments and tempo- rary cylinders. Seven days postoperatively the patient returned with very little discomfort, swelling, or bruising. She was very pleased with her fixed provisional restorations (Fig. 8). Now that the patient was no longer anaes- thetised, the occlusion was checked again to confirm there were no in- terferences in lateral and protrusive movements. The next step in her treatment would consist of impres- sions for the definitive upper and lower restorations approximately 4 to 5 months postoperatively. Approximately 16 weeks after im- plant placement, the patient re- turned for the prosthetic phase of her treatment. The gingival tissue www.celtra-dentsplysirona.com CEREC® CAD/CAM Solutions Designed to simply work better together Celtra® D)o (ZLS) blocks, Prime&Bond )niversal™ Adhesive, and Calibra® Ceram Cement were designed to enhance and strengthen the individ)al benefits each of them provides, res)lting in an easy-to-)se system that streamlines the restoration process. Celtra Duo (ZLS) blocks • Restoration longevity of Celtra D)o (ZLS) is ens)red when )sed with Prime&Bond )niversal Adhesive and Calibra Ceram Cement • Firing is optional: choose either fire and seat or polish and seat Prime&Bond universal Adhesive • No need to )se a self c)re activator when )sed with Calibra Ceram Cement • Low film thickness to allow passive seating of the crown Calibra Ceram Cement • One-step c)ring when )sed with Prime&Bond )niversal Adhesive • 10-second tack c)re window and 45-second gel phase ens)res an easy, no-stress clean)p