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36 | CERECDOCTORS.COM | QUARTER 1 | 2014
sometimes, we learn thatwhatwe
have always accepted and taken for
granted as the right thing to do can turn
out to not be the best.
Not that itwaswrongwhen itwas done.
But, as we gain experience, we realize that
things could have been done better. That
is why we say we practice dentistry.
Implant dentistry is no different. In
fact, we can say right now that implant
dentistry is changing faster than other
areas of dentistry. New techniques and
materials are being introduced that
open the door to more efficient and
cost-effective treatment options for
the dentist — especially the CEREC-
equipped dentist.
The ability to integrate our CEREC
scans with our Galileos cone beam
scans have revolutionized our place-
ment philosophy. Prosthetically driven
implant dentistry allows us to get the
most predicable esthetic restorations;
the integration simplifies the process of
planning. The ability to generate accu-
rate guides ensures we can convert our
digital plans into reality in the patient’s
mouth, with the side benefits of
decreasing the surgical time, decreasing
the post-op discomfort for our patient
and allowing us to remove any of the
“unknowns” that can drive up the price
of treatment.
The next major step in this refinement
of our implant therapy is the release of
new materials that allow the CEREC
dentist to restore these well-placed
implants in a cost-effective
manner. No special equip-
ment or special techniques
need to be used; Ivoclar has
Implant Restorations:
A Historical Perspective
Life Is a Journey of Learning; Experiences Direct Our Path
C A S E S T U D Y | | | B Y P E T E G A R D E L L , D . D . S .
abutment. It was before we had quali-
fied labs that could successfully cast
a custom abutment with a perfect
implant-mating surface. We had a stan-
dard abutment with a restorative inter-
face at tissue level. In this situation, the
contour would emerge unnaturally from
this 4-mm diameter circle to a cross
section of a natural tooth. Ridge lap
pontics were done to create the optical
illusion of a correct emerging contour.
Figure 2 is a diagram from the Brane-
mark Instructional manual printed in
1988, and demonstrates the restorative
philosophy of the day.
This pontic mentality created a resto-
ration that is difficult for the patient
to maintain; this could be one of the
factors for the continued bone loss in
this patient’s case.
Other than the occasional screw
breaking, they served our patient well.
delivered an e.max mesoblock,
and Sirona has delivered the
parts and the tools in the 4.2
software for ideal abutment
planning and fabrication.
Here is a case that demon-
strates how, as a profession,
we have evolved with our
approach to implant therapy.
CASE STUDY
Larry is a long-time patient who
had existing implant restora-
tions. Teeth #3 and #4 were
replaced with Branemark
external hex implants, restored
with standard abutments and a
screw-retained,two-unitbridge.
As you can see in Figure 1,
the tissue surface of the bridge was a
ridge lap design. This was a common
practice when these were placed and
restored in 1988. Both the oral surgeon
and the prosthodontist followed the
conventional wisdom of the day: place
the implants where the best bone is seen
after flap reflection; after integration,
the restoring dentist would then use
ingenuity to restore the implants to the
best of his ability to create something
that mimics a tooth. This process is
much like what we do when we replace
a failingtooth with a pontic.
The other interesting step by the
restoring doctor was placement of a
precision attachment on tooth #5; he
used ingenuity to restore, but perhaps
didn’t have confidence in the success
rate of implants at the time of placement.
This restoration was before the early
work ofJohn Beumer and his UCLA
1
3
2
Fig. 1: Pre-op
radiograph
Fig. 2: Instructional
manual diagram
Fig. 3: Models
of case