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Dental Tribune Middle East & Africa Edition | 6/2017 IMPLANT TRIBUNE D3 ◊Page D2 Fig. 9: Scanned abutments at the frontal section for the sake of design- ing telescopic crowns. Fig. 10: A design of primary telescopic crowns from zirconium oxide Fig. 11: Transparency on to make the thickness of the walls of the crowns visible along with the position of the abutments. Each treatment should start with a well-prepared plan. For most pa- tients appearance after treatment will always be very important that is why an intraoral analysis must be made in order to assess the static structure of the mouth, as well as an analysis of the lips’ dynamics along with teeth exposure during speak- ing and smiling (Figs. 1 & 2). We analysed the aesthetic aspects in a way that enables us to reach an optimal balance between white (teeth) and pink (gums) aesthet- ics. Of course, in toothless patients, one should take note of the fact that teeth setup as well as reconstruction of atrophied tissues will constitute a support for the lips. Such an analy- sis may be made on the basis of a restoration that the patient uses. In this case, first sanitation of the max- illa had to be performed, next a tem- porary acrylic prosthesis was made. In the next phase, implants were inserted. In compliance with the results of the CBCT study, a sinus lift procedure was performed with a simultaneous implantation in the region of lateral teeth. Eight Ankylos implants were introduced, raising both maxillary sinuses at the same time. After six weeks, the implant exposure procedure was performed. Because of the fact that implants were partially anchored into the bone at the lateral section, partially within the augmentation mate- rial while primary stability was achieved, we decided to expose implants at lateral sections without occlusal load so as to perform the so called bone training with a view to improving the condition of the bone being regenerated. An impres- sion was taken (Figs. 7 & 8) for the positional model and for the prepa- ration of the temporary prosthesis based on telescopes. The model was scanned while the abutments were made ready in such a way that they could serve as telescopic crowns, also in the final stage (Fig. 9). Primary and secondary telescopic crowns were designed on the abut- ments (Figs. 10 & 11) on the assump- tion that secondary crowns had been made ready twice, that is, for the sake of temporary prosthesis and at the same time for gluing it into the final construction (Figs. 12 & 13). Abutments were mounted on implants by means of Pattern Resin (Figs. 14 & 15) in such a way that the position does not change during mounting. A temporary skeletal prosthesis, based on four telescopes, shall be placed on such a foundation (Figs. 16 & 17). Primary telescopic crowns were glued last (Fig. 18). Work completed in cooperation with Inter-Dent laboratory in Warsaw, Po- land. Secondary telescopic crowns, made from acetal by means of the CAD/ CAM virtual designing method, were tried on primary crowns (Fig. 19). Figures from 20 to 22 present a macroscopic view of zirconia pri- mary crowns testing and acetal sec- ondary crowns. At that stage, our patient received a temporary prosthesis, while lateral implants remained unloaded (Figs. 23 & 24). In the second part of the ar- ticle, we will present the designing process (Figs. 25 and 26) along with the process of manufacture of the fi- nal construction made from TRINIA material with glued zirconia crowns as well as veneering by means of pink composite material. Editorial note: This article is the first one from the two parts series. Part II will appear in CAD/CAM 2/2017. Dr. Tomasz Śmigiel graduated from Sile- sian Medical Universi- ty in 1997. Author of multiple publications for specialist maga- zines about dentistry and a lecturer at nu- merous congresses. In 2012, he was certi- fied with the title of a Master of Science in Oral Implantology at the J.W. Goethe- University in Frankfurt/Main, where he conducted research on an innovative sys- tem of synthetic telescopes. He is also the co-founder and a board member of Implant Masters Poland, a non-profit association. He can be contact- ed at tomasz@smigiel.net Fig. 12: Secondary telescopic crowns made from ac- etal resin prior to being glued into the construction Fig. 13: Primary telescopic crowns made from zirconia, packed and designated. Fig. 14: Transfer of abutments from the model to the mouth by means of pattern resin Fig. 15: Tightened abutments prior to the mounting of primary telescopic crowns. Fig. 16: Temporary telescopic prosthesis, of skeletal type. Fig. 17: Temporary telescopic prosthesis of skeletal type: inside of the denture Fig. 18: Mounted primary telescopic crowns made from zirconia, on abutments. Fig. 19: Test of secondary telescopic crowns made from acetal resin Fig. 20: Primary zirconia crowns in situ (right-hand side). Fig. 21: Primary zirconia crowns in situ (left-hand side) together with a secondary crown made from acetal resin as a try. Fig. 22: A set of telescopic crowns (palatal view) prior to being installed into the skeletal prosthesis. Fig. 23: Palatal view of functional telescopic crowns and exposed implants. Fig. 24: Telescopic denture of skeletal type enables the patient to func- tion comfortably during the transitory period. It also enables checking the aesthetics and functionality before the final screw based restoration is finished. Fig. 25: Design of the final restoration Fig. 26: Scan of the temporary prosthesis (in blue) to visualise the space needed to make porcelain crowns.