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48 | CERECDOCTORS.COM | QUARTER 3 | 2014
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out there. Lab kits allow one to not only
accurately place the implant at the correct
depth and angulation, they also allow for
precise clocking of the implant. Depth,
angulation and rotation — all the condi-
tions that need to be captured in a quality
final impression to allow for fabrication of
the final prosthesis.
The original rstimg file image of Lucy’s
case was imported back into CEREC, to
save time. There is no reason to have to
redo thework it takes to produce a perfect
scan. Importing the video streams allowed
for using the Cut tool to remove the area
that was modified and re-image a small
segment. It took just seconds to do.
Simply cut out #12 and #13, and image
the healed gingiva for planning out the
final restorations. This is true prostheti-
cally driven implant dentistry in a clean
and efficient way.
This restoration was exported to the
Galaxis software enabling the proper
planningof the implant.Weknowtheend
point: the bone, and can set the correct
depth to allow for soft-tissue support
and stability. These factors add up to
successful implant therapy, and we end
up with a result that looks like a tooth. If
we end up with the patient saying they
got a crown on an implant, we have not
done the job to the best of our ability. An
OptiGuide was desired for this case, and
the file sent to SiCat for fabrication.
Now let’s look at what we know: the
more the soft tissue is manipulated the
more likely the chance of a complica-
tion. The more a healing abutment or a
provisional is manipulated, the weaker
the soft tissue adhesions become.
Zirconia has proven to be a kind mate-
rial to soft tissue, allowing for strong
adhesion to develop when the area heals
(in other words, great biocompatibility).
The strongest adhesions develop at the
first surgery, either at the placement for
the single stage or the uncovering for
the second stage. The research that has
been done demonstrates that e.max also
is very forgiving to the soft tissue. Great
reports of cell adhesion, allowing for
stable soft tissue.
In Lucy’s case, I took the opportunity
to send out her full-arch scans to get
SLA models produced. On these, I was
able to use the guide from SiCat and a
lab kit to place an analog in the planned
position. An SLA-otomy was performed
with an acrylic bur to allow for the place-
ment of the analog into the model. The
correct implant lab carrier was identi-
fied in the SiCat recipe and selected,
and the implant analog attached. In
this case, Triad was used to lock the
analog into the SLA model, a light-
cured, hard-setting material. Figure 6
shows the result of this quick-and-easy
process. Figure 7 is the full intraoral scan
of Lucy where the model had teeth #12
and #13 cut out, and the modified SLA
model scanned tofill in themodified area.
Before, the components would involve
a lot of work and, more importantly, a
lot of expense. I want to note that full
zirconia custom abutments that are
designed and fabricated by a lab have
been a great option to restore implants,
and they still have a role for certain
conditions. But there is a new player
as of late that is quickly proving that it
should be the first option. Ivoclar’s e.max
meso block, in combination with Sirona’s
TiBase, is revolutionizing the workflow
of restoring implants for the CAD/ CAM
dentist. Bothallowfor theCERECdentist
to take control of the process, including
emergence from implant interface to the
final profile of the definitive restoration.
After this process, we can now
approach this case as any custom abut-
ment case, either by a live intraoral scan
or off of an implant-level impression
The simple, step-by-step CEREC
workflow is followed, resulting in a
perfect abutment for the situation and a
veneer crown. Since we are to place this
at time of surgery, the occlusal portion of
the abutment was reduced to allow for
a Lava Ultimate crown to be made that
did not contact in centric or in function.
After the milling of the e.max abut-
ment, the sprue was removed and the
tissue-bearing surface polished prior to
crystalizing. Ivoclar recommends that
you only polish the tissue-contacting
surface and not glaze it, because this
allows for best cell adhesion while
decreasing the formation of biofilm. A
Lava Ultimate crown was planned to be
placed during the healing stage of this
treatment. This material is very easy to
adjust and polish in case it is found to be
contacting the opposing teeth in func-
tion. The Lava cantilever bridge would
be re-used after it was sectioned.
6 7
8 9
Fig. 6: SLA model with Analog and
Scan post
Fig. 7: Combination CEREC scan of case
Fig. 8: Post graft implant site
Fig. 9: Optiguide in place