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QUARTER 3 | 2014 | CERECDOCTORS.COM | 25
level implant, minor bone grafting at the
time of implant placement and an imme-
diate provisional restoration that was out
of function. Even though the plan was
likely to be successful, one technique
we employ in the case that immediate
provisionalization is not possible, is to
be prepared with another provisional
option. This consists of a prefabricated
resin-bonded (Maryland) bridge.
It is quite simple to prefabricate
a Maryland bridge when you have a
wax-up model (Fig. 4). We duplicated
the model and very carefully cut out
tooth #6 with a fine carbide bur. Take
note that we place the cervical margins
in the stone in a way we would like the
final pontic to be shaped (Fig. 5).
In theCERECsoftware (BridgeMode),
we can fabricate the Maryland bridge.
This is going to be a one-wing Maryland
bridge with the wing (lingual veneer) on
the lateral incisor. One tip to make sure
that you get the pontic margins in the
perfect location to support the pontic,
is to overlay the Biocopy of #6 when
drawing the margins (Fig. 6).
Because we are creating the pontic
directly from the wax-upmodel, you can
simply draw the copy line around #6 to
accurately duplicate the desired tooth
position (Figs. 7 and 8). This restoration
was milled out of Telio CAD PMMA
material and prepared for the surgery
appointment (Figs. 9 and 10). By doing
this, you spend minimal amount of time
(and no patient chair time) fabricating
an inexpensive restoration that is ready
in case you need it after implant place-
ment. Best of all, it is a fixed and not a
removable solution that is easily bonded
on for the osseointegration time frame.
In this case, the surgery and grafting
procedures done by Dr. Boltchi were
successful and everything was set up
perfect to perform an immediate provi-
sional. In the past, this would be one
of the most difficult, time-consuming
procedures to perform at surgery. You
would have to use Temporary Abut-
ments that often needed alterations,
take implant-level impressions and
spend a lot of chair time fabricating the
provisional. That is, it was not always a
completely digital solution.
Ivoclar Vivadent has already delivered
an e.max CAD abutment block that has
revolutionized chairside implant final
restorations. Now, they have manufac-
tured a PMMA abutment block (Telio
CAD) for fully digital implant provisional
restorations. This block (due fall, 2014)
fits the appropriate SironaTiBase exactly,
allowing you to scan the implant position
in the mouth with the Sirona ScanPosts
and ScanBodies (Figs. 11-14).
Fig. 4: Wax-up model
Fig. 5: Pontic site development
Fig. 6: Margination with Biocopy overlay
Figs. 7-8: Copy line drawn
Fig. 9: Buccal view of provisional bridge
Fig. 10: Palatal view of provisional bridge
Figs. 11-14: Different stages of milling
provisional crown
5
6 8
10 9
4
7
13 14 11 12