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CERECDOCTORS.COM
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QUARTER 1
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2014
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manipulationtoensureasatisfactoryresult.
Once the crown was proposed, the
emergence was smoothed and shaped
using the same design tools that are used
to design a crown. The overall contours
were created with the Form and Shape
tools (Fig. 7). The screw was positioned
centrically to increase the longevity and
success of the restoration; the more
centered the screw access can be made,
the better. It was also important to avoid
impinging on the gingival tissues too
heavily. The embrasures were closed off,
and the buccal contours were finished
using the gingival mask.
The crown restorationwas thenmilled
(Fig. 8). Since there was a predetermined
hole, the position of the crown could
not be altered in the mill preview. Once
the crown was milled, it was character-
ized and sintered. The TiBase (Sirona
Dental Solutions, LLC) was roughened
with a micro etcher, and Monobond
Plus (Ivoclar Vivadent) was applied
and allowed to dry for one minute. The
internal surface of the meso crown was
etched with 5 percent hydrofluoric acid
for 20 seconds (15 seconds if using the 9
percent hydrofluoric acid). Monobond
Plus was then applied to the internal
surface and allowed to dry for one
minute. This was completed along the
entire length of the predrilled hole.
A thin layer of Multilink Hybrid Abut-
ment cement (Ivoclar Vivadent)was then
applied to the TiBase in the area where
the abutment crown would engage. Indi-
cated for IPS e.max CAD restorations,
Multilink Hybrid Abutment cement
is a self-curing luting composite that
provides a long-lasting bond, optimal
esthetics, and easy handling with a
convenient automix syringe.
The abutment crown was seated on
the TiBase and the excess cement was
cleaned up (Figs. 9-10). The cement was
allowed to set (or it can be cured with a
curinglight).Onceset,thescrew-retained
crown and abutment combination was
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O ’ B RYA N
ready for transfer to the mouth.
The complete restoration was taken
to the patient’s mouth and seated on the
implant. The screw was placed in the
access hole and torqued to 25 ncm. Once
the screw was torqued, it sat for about
five minutes to let any stress relax. It was
re-torqued to 25 ncm. This virtually elim-
inated any risk of the screw loosening.
Once the screw was placed, Teflon
tape was placed over it as a spacer to
prevent composite-filling material from
spreading to the engaging portion of the
screw. The access opening of the previ-
ously conditioned crown was filled with
a bulk fill composite (Tetric EvoCeram
Bulk Fill, Ivoclar Vivadent) (Figs. 11-12).
CONCLUSION
While much debate remains over abut-
ment and implant techniques and
materials, IPSe.maxCADAbutment Solu-
tions provide ideal options for fabricating
implant-supported abutment/restoration
structures. Easily customizable through
CAD/CAM technologies and CEREC
software, IPS e.max CADAbutment Solu-
tions increase the precision, esthetics
and strength of all-ceramic, implant-
supported restorations. With the milling
completed in-office, this restorative solu-
tion revolutionizes implant restorative
dentistry by providing an efficient and
esthetic alternative to prefabricated and
laboratory-fabricated abutments.
For questions or more information,
Dr. O’Bryan can be reached at
Editor’s note: References for this article
are available upon request.
Fig. 8: The crown was milled using the
CAD/CAMCEREC software
Fig. 9: The abutment crown was seated
on the TiBase using Multilink
Hybrid Abutment cement
Fig. 10: Once the cement set, the
screw-retained crown was ready
to be transferred into the mouth
and placed
Fig. 11: The final restoration seated and
completed in the patient’s mouth
Fig. 12: The final restoration displaying
a complete match to the surrounding
dentition and high esthetics, with
excellent gingival contouring
