2-Visit replacement Protocol. Front tooth.100% CAD-CAM

12 Rating(s).


Posted on By Anton Andrews In Digital Scanning & CAD/CAM

This time DENTOLOGY 2-visit tooth replacement protocol was utilized on the lower anterior tooth #23.
The incisor had been lost due to a trauma around a year before the initial consultation.
1st-visit: Implant placement + GBR + TRIOS scan
2nd- visit: Implant uncovery, buccal flap repositioning with roll technique, delivery of the final FCZ , screw-retained crown.

RRR- Reversed Restorative Rehabilitation Technique was employed for CAD.
Comments?Questions?

initial view. Scanned intraorally with TRIOS (3Shape)
initial occlusal view

CAD for RRR utilizing Dental Designer 3SHAPE
CAD frontal view. Angulation of the screw access hole was changed to avoid the incisal edge.


Add to Favorites
Add a comment to the discussion on 2-Visit replacement Protocol. Front tooth.100% CAD-CAM


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

15 Comments

How do you adjust for tissue healing?


Reply

Hi Maurice, thanks for the great question.
In general, I design a restoration with RRR to guide ST where its suppose to be.
In complicated cases - multiunits etc, where contours adjustment ( add-on) is necessary, I can remove the restoration at any time and add porcelain, EX: in the pontic area. Out of hundreds of restorations I placed,so far, I had to do it only once.

final x-ray


Reply

Anton. Nice work flow. Is it possible with this material (if desired) to fabricate a smaller diameter abutment at the platform level? Thank you for sharing. Best regards. Chuck


Reply

Hi Charles,
As always your comment is right in a bullseye!
I found it is an issue with platforms like zimmer.
I used 3.7 mm implantdirect legacy 2 implant with 3.5 platform.
you can see from the crossection the thickness for zirconia is only 0.4mm. I don't think there is a room for trimming, although on 4.5 and 5.7 mm platform I do that on the regular basis with subcrestal placement.
I am not worried for this case, since I performed it with "one everything - one time", as you called it. There is a great response from ST with papillae formation within 3 weeks post placement.
Great question!

Crossection at the abutment level
dental-continuing-education.com


Reply

Anton,
great case my compliment.
First of all a very ACCURATE digital impression, with minor 'holes': I rarely see that and often wonder about final work accuracy if initial data are inadequate.
Secondly I like the planning idea and the way was developped.
My concern as you pointed out is the specific use of zirconia here : thickness could be an issue in long term stability.
As Maurice pointed out you may have to work on soft and maybe hard tissue to find final sitting of crown over the implant.
Thanks for sharing.
Armando


Reply

Thank you for compliments Armando.
Yes , i had to remove the bone from above the implant and slightly on the proximal sided as well as to manipulate the St with the roll technique. But these are all attributes of the "normal implant uncovery process" . The main advantage of this concept that CAD for the final restoration is made with RRR to keep the stability of the tissues on the long run.


Reply

Anton; Very nicely done. Your approach for everyday implant dentistry will soon be the standard. Regards, gerald


Reply

Thank you Gerald!


Reply

Thank you for the case! I also find it is difficult on small diameter implant to place zirconia abutments or restorations , it created reverse platform switch and affects cosmetics. In your case I would trim interpoximals and buccal area to give more room for gum. Gregory


Reply

I agree with you ,Mark, regarding negative platform switch, although in this case it's not an issue. The Zi abutment measured 4.26 - The implant diameter 3.7 = 0.56 mm . This is 0.28 mm negative switch. With 0.3 -0.4mm zirconia thickness there is no way to trim it. As I'd mentioned I trim on 4.5 and 5.7 mm when necessary.


Reply

Hi Anton ,

Great case. Where do you get your scan bodies for implant direct or zimmer?

Regards


Reply

For implant issue i will recommend you Dr. Arthur Kezian (http://www.drkezian.com)


Reply

Andoni, I use NT-trading scan bodies and ti-bases but after going through few hundreds of restorations I realized that their products would benefit from certain improvements.


Reply

What is your prefered procedure to scan non hexed srew retained fixed metal bars for implant Restorations? Do you scan the working cast hexagons or do you use special post when using 3 shape cad?


Reply

Hi Lydia, I do not use metal bars because they are ugly.


Reply

Related Posts


KLS Martin
Nobel Biocare