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2014
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this tool, you are able to change the loca-
tion and the width of you shoulder. In
Larry’s case, you can see in Figure 14
how themargin has been placed approxi-
mately 0.5 mm sub-gingival on the facial,
mesial and distal while it is slightly
supra-gingival on the palatal. The posi-
tion can be seen easily when the Gingival
Mask view option is turned on and it is
made semi-transparent. This allows for
great esthetics and easy clean-up of the
cement when placed. The shade of the
e.max block is an LT A3.5, which mimics
the shade of his dentin.
Bydecreasing thewidthof theshoulder
on the facial, we can use an HT A2 e.max
block for the veneering crown. By using
different translucencies, we can mimic
what Mother Nature has produced and
give depth andwarmth to our restoration
(Fig. 15). Delivery is predictable; the abut-
ment drops in with the proper support of
the soft tissue as seen in Figure 16. At two
weeks, the great tissue response is seen in
Figures 17-18.
Ivoclar has done research on e.max
and its biocompatibility, and it has led to
the following recommendations:
• The strongest adhesions are to a
surface polished only; this surface will
not increase the formation of biofilms.
Details can be seen in the Abutment
videos in the digital learning section of
the cerecdoctors.com website. The apex
of the scan cap is double-clicked and the
software will go through the process of
inserting the implant you have selected
into the virtual model. The insertion
angle of the implant is then set, along
with the defining of the cross-sectional
profile of the abutment.
It might seem wrong, but now a
proposal for a full-contour crown is
rendered. It is not wrong; it is, in reality,
so right! Today, we do not have any
excuses not to provide the best esthetic
and function to our patients. The path
to this is to design the perfect crown —
something that fits in with the occlusion
of the patient and the profile of the adja-
cent teeth. Once you have done this, you
can activate the Split tool and create the
perfect abutment that will support your
ideal crown. Figure 13 shows the abut-
ment and the proposed crown after the
split function. A second file is created
for this case, one for the abutment and
one for the veneering crown. The tools
available to modify the abutment design
are slightly different.
The Scale tool is the most powerful of
the new abutment-specific tools. With
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Fig. 13: Abutment and crown proposal
Fig. 14: Margin placement
Fig. 15: Final complex
Fig. 16: Abutment placed
Figs. 17-18: Tissue response
• Glazing of the subgingival areas is
not recommended for best long-term
performance of custom abutment.
• Strength has also been tested. In
numerous tests, e.max abutments that
have been cemented to the TiBase
with Multilink Hybrid Abutment
Cement had no failures. Abutment
screws and fixtures broke before the
e.max and cement failed.
CONCLUSION
The addition of new software features
and new materials from our partners
are allowing us to raise the bar. We now
have total control of our implant therapy,
from planning to restoration. We get
total control of the costs to perform this
treatment, which has a significant effect
on howwe present this treatment to our
patients. We can give them a bottom line
that makes sense to them and makes
them say “yes” to treatment.
With all the tools at our fingertips, we
should no longer be happywith the place-
ment of a crown on an implant.We should
strive to recreate what was lost: a tooth.
For questions and more information,
Dr. Gardell can be reached at
.
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