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20 | CERECDOCTORS.COM | QUARTER 1 | 2014
be restored. The provisional success-
fully formed the gingival contours to an
ideal position and recreated the natural
papillae necessary for an optimal result
(Fig. 11). This tissue is not only critical for
esthetics, but also for the software. The
first scan recorded with the Omnicam
will be the final gingival contours.
This will be scanned in a catalog
called Gingival Mask. Because the
tissue will slump as soon as you
remove the provisional, it is impor-
tant that you scan the gingival
contours immediately following
removal of the screw-retained
provisional. When designing the
final restoration, it is paramount to
know not only the position of the
healed tissue, but also for deter-
mining the amount of gingival pressure
placed by the hybrid abutment crown.
After scanning the Gingival Mask,
we next image the opposing dentition,
Buccal Bite (to relate the upper and
lower models) and the Scan Body with
the CEREC Omnicam. The Scan Body is a plastic cap placed
over a Sirona TiBase or ScanPost that relates the implant
position, depth and rotation/timing to the software (Fig. 12).
The inside of the Scan Body also has the female receptor
(much like the e.max abutment block) that corresponds to
the male “notch” on the Sirona TiBase or ScanPost. This
ensures that the implant information is accurately conveyed
to the software for design of the final restoration. The Sirona
TiBase (Fig. 2) is used with the Scan Body when imaging an
implant position off a model and a Sirona ScanPost (Fig. 13)
is used when imaging a Scan Body intraorally. The ScanPost
is a reusable digital impression post that is much longer than
the TiBase, allowing much easier placement of the Scan
Body in most clinical situations.
Materials needed to restore an implantwith theCERECAbut-
ment software (part of the 4.2 software) include:
sirona tibase kit: These can be purchased from Patterson
Dental (in U.S.) and include the TiBase, white Scan Body
and final titanium screw. You purchase these based on the
implant manufacturer and size.
grey scan body: These can be purchased from Patterson
Dental (in U.S.) and are meant to be used in place of the
white Scan Body with the CEREC Omnicam.
sirona scanpost: These can be
purchased from Patterson Dental
(in U.S.) and are reusable digital
impression posts to place the Scan
Body on intraorally. There are Scan-
Posts available for each implant
manufacturer and size.
e.max abutment block:
Either A14 MO or A16
LT, depending on
whether you’re doing
a hybrid abutment or
hybrid abutment crown.
After taking the digital
impressions, the CEREC
4.2 chairside software
has an Abutment option listed under “Restoration Types.”
You can use any DesignMode (Biogeneric Individual, Bioge-
neric Copy, or Biogeneric Reference) to design your resto-
ration. You also have the option to select Multilayer if you
wish to do a hybrid abutment. What Multilayer does is split
a final crown design into both a Veneering Structure (final
crown) and Framework (abutment). In this case study, we
will be designing a hybrid abutment crown (no Multilayer)
in Biogeneric Individual.
When designing your implant restoration, you have the
option to define the restoration axis (Fig. 14). The long axis
of the implant itself is indicated by a red dotted line in this
step. The yellow arrow shows the long axis of the implant
restoration itself. This allows you to make angled hybrid
abutments or hybrid abutment crowns in relation to the
TiBase up to 20 degrees.
After completing the final Biogeneric design of the hybrid
abutment crown (Fig. 15), you have the ability to turn the
Gingival Mask folder transparent to evaluate and customize
the emergence profile and tissue pressure. This allows total
control of not only the contours of the restoration, but also
the gingival architecture. By removing themodel completely,
you can do the final optimization of the emergence profile
and visualize how it emerges from the implant (Fig. 16).
| | | S K R A M S TA D
14
15 16
12
13
Fig. 12: Scan body in place
Fig. 13: Sirona ScanPost
Fig. 14: Defining restoration axis
Fig. 15: Design of hybrid
abutment crown
Fig. 16: Visualizing emergence
profile