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cerecdoctors.com
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quarter 3
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2013
have the proper equipment) or sent to a
lab to be milled and sintered (Fig. 27). I
sent my file out to the lab. This only takes
two days to get back from the lab. When
I got the email from the lab that the abut-
ment was being shipped, I then milled
out the crown that was designed out of
an e.max HT shade A3 (Fig. 28).
At this time I also prepared the TiBase
for the zirconium abutment (Fig. 29).
The portion of the TiBase that engages
the abutment is air abraded with a
Danville micro etcher and 50 micron
aluminum oxide. When the zirconium
abutment arrived, Monobond+ from
Ivoclar was applied to the internal aspect
of the zirconium where it would engage
the TiBase and on the corresponding
portion of the TiBase that had been air
abraded (Figs. 30-31). This application of
Monobond + was allowed to air dry for
one minute. Multilink Implant was then
applied to the TiBase circumferentially
and the zirconium abutment was seated
on to the TiBase. The excess cement
was cleaned up around the edges of the
TiBase, and any in the access hole was
removed.
Places where the TiBase and the abut-
ment meet were then polished to make
sure no residual resin would be close to
the implant. The final complex is then
ready for delivery (Fig. 32).
The patient returned two days later
after scanning for the final placement of
the restoration. The screw-retained is
removed. The abutment is placed in the
crown to act as a carrier and to orient the
abutment in the implant with relation
to the restoration. Once the abutment is
seated and it engages the anti-rotation
with proper orientation, the screw is
torqued to 25ncm. The margin is just
below the gingival crest on the facial as
was planned in the software (Fig. 33).
The access hole is then filled with Teflon
tape to allow for retrieve if ever the screw
were to loosen (Fig. 34).
Once the abutment is torqued into
place, the crown is tried in. The occlu-
sion is verified and adjusted as needed.
The virtual articulation function in 4.2
reduces the amount of time needed to
spend adjusting the crown by allowing
us to design the restoration without
interferences. After all adjustments are
made, the patient is asked to evaluate
the esthetics and feel of the restoration.
After we got the okay from the patient
that she was happy, the crown was
cemented with Rely X luting cement.
The excess was cleaned up with ease
since the margins were designed just
below, or in the case of the lingual and
interproximal at the gingival margin. I
prefer to cement my implant restora-
tion with a luting cement to allow for
easy retrieval in case of screw loosening.
When luting cement is used and a screw
gets loose, a slot can be cut in the crown
and the e.max can then be fractured off,
33
34
35
36
the screw tightened and a new crown
fabricated without having to damage the
underlying abutment.
The final restoration shows excellent
esthetics and flows within the arch form
(Fig. 35). The emergence profile given by
the custom abutment and temporization
at time of implant placement makes the
restoration indiscernible from a natural
tooth (Fig. 36).
CONCLUSION
Patients want teeth, so planning the
implant based on that leads to a better
outcome and patient experience. The
coupling of CEREC and Galileos allows
the restorative dentist to have a map to
plot out the implant placement based
on the restorative outcome. This leads
to more ideal implant placement that, in
turn, leads to better tissue response from
immediate temporization and a better
final restoration. The final outcome is a
surgical restorative complex that is more
predictable and efficient, as well as safer
and more esthetic for the patient and the
treating doctor.
For questions and more information,
Dr. O’Bryan can be reached at
Fig. 33: Abutment placed
Fig. 34: Abutment screw access hole
Fig. 35: Final restoration placed
Fig. 36: Crown emergence profile
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O ’ B rya n
