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PUBLISHED IN DUBAI www.dental-tribune.me March-April 2018 | No. 2, Vol. 8 A case study using Dentsply Sirona’s Celtra® Press System SUBSCRIBE NOW www.me.dental-tribune.com/e-paper/ issn 1616-7390 Vol. 8 • Issue 4/2017 CAD/CAM international magazine of digital dentistry Aesthetic rehabilitation of the anterior mandible after tooth loss due to periodontal disease 42017 By Dentsply Sirona Tooth loss in the anterior mandibular region can be a challenging situation for dentists and dental technicians tasked to provide an aesthetically pleasing prosthetic rehabilitation. For reasons of stability, a solid, tor- sion-resistant framework is a must in these cases. Metal frameworks have the drawback that thinner ceramic veneer layers may yield aesthetically less satisfactory results. Monolithic zirconia frameworks usually do not meet the aesthetic requirements of the dentist and patient in these situ- ations. However, care must be taken to ensure sufficient strength even for delicate bridges to achieve satisfac- tory long-term results. The case described here was treated with the new Celtra® Press press- able ceramic system. This outstand- ing system combines high strength with brilliant aesthetics and is ideally suited for demanding cases such as this one. Case report The patient first presented in De- cember 2015 with no systemic condi- tions, except that the patient was al- lergic to penicillin. A few years earlier she had been diagnosed with perio- dontitis, in the course of which tooth #24 had become mobile and had had to be extracted. Prosthetic reha- bilitation was performed at another dentist with an adhesive bridge from tooth #23 to tooth #25. This bridge had loosened several times and had to be re-bonded at regular intervals. There was a ceramic implant at site #12, and all four quadrants included posterior teeth with ceramic inlays or partial crowns as well as compos- ite fillings. Horizontal bone loss due to persistent chronic periodontal disease in the posterior region was evident radiographically. The patient requested an aesthetic, durable and stable restoration for teeth #23 to #25 and rejected an implant-supported crown at site #24. Having presented several alter- native types of bridge restorations, the patient and dentist opted for a bridge made of a highly translucent all-ceramic material. As this case re- quired both excellent aesthetics and high strength, we decided to use the Celtra® Press high-strength ceramic system. The shade of the teeth was taken and the teeth were prepared under infil- tration anesthesia, followed by tak- ing an impression and by recording the habitual occlusion. The prepared teeth received a temporary acrylic resin restoration (Figs. 1 to 4). In the dental laboratory, a saw-cut model was created and the prepara- tion margins defined cleanly and precisely with the aid of a micro- scope (Fig. 5). The casts were scanned and the data imported into the CAD software. Thanks to the highly pre- interview “Dentistry has finally arrived in the digital age” case report Screw-retained implant-supported restoration in the edentulous maxilla CONE BEAM supplement Dynamic navigation for reliable and predictable flapless implant placement cise definition of the preparation margins, the software recognised them with 100% accuracy and inte- grated the data within fractions of a second (Figs. 6 and 7). The models were placed in the virtual articulator ÿPage B2 Fig. 1: Clinical baseline situation and shade selection. Fig. 2: Preparation of the abutment teeth. Fig. 3: Precision impressions. Fig. 4: Provisionalization. Fig. 5: Model dies with accurate representations of the preparation margins. Fig. 6: Representation of the dies in the CAD software. Fig. 7: Detail of the preparation margin. Fig. 8: The models in the virtual articulator. Fig. 9: Bridge design using the CAD software. Fig. 10: Reduction of the vestibular surfaces for the cut-back method. Fig. 11: Finishing the contours. Fig. 12: Cut-back and layering technique using Cercon® base wax. Fig. 13: Only a single sprue needs to be attached to the bridges. Fig. 14: Detail of the sprue. Fig. 15: Investing with Celtra® Press Investment. Fig. 16: Placing the muffle in the pressing furnace. Fig. 17: Divesting. Fig. 18: After divesting, no reaction layer is present on the objects. Fig. 19: Framework after sandblasting: no reaction layer and crisply defined structures. Fig. 20: Excellent initial fit, no finishing needed.