39
ProvisionalHybridAbutmentCrownA16block, adjustedandpolished,
and then bonded to a Sirona TiBase for the StraumannNCBone Level
implantwith the IvoclarMultilinkHybridAbutment Cement (Fig. 26).
The completed provisional restoration was adjusted to reduce the
shoulder diameter of the TiBase to avoid any undue pressure on the
adjacenttissuesduringthehealingphase(Fig.27).Thismodifiedscrew-
retained provisional restorationwas screwed onto the implant and the
occlusion adjusted to ensure that the restorationwas completely out of
occlusion in all centric, lateral, and protrusive jawmovements to avoid
any loading of the implant, which could result in micromotion during
theimplantosseointegrationphase(Figs.28-29).Therestorativedesign
of this provisional restoration intentionally left the gingival embrasures
open to allow for soft tissue adaptation and papillary ingrowth during
the healing phase (Fig. 28).
After an uneventful healing period
of 8 weeks the implant demonstrated
complete stability with excellent soft
tissue adaptation to the provisional
restoration and complete papillary
tissue ingrowth into the previously
open embrasure spaces (Fig. 30). The
previous digital full contour design in
the CEREC software was used to mill
the final screw-retained restoration out
of an Ivoclar e.max Hybrid Abutment
Crown A16 block, which was bonded
to a Straumann NC Bone Level Vario-
base for CEREC with the
Ivoclar Multilink Hybrid
Abutment Cement to
obtain a one-piece screw-
retained implant crown
(Fig. 31). The provi-
sional restoration was
removed revealing an
ideally contoured peri-
implant soft tissue transi-
tionzone (Figs. 32-33), the
screw-retained implant
crown was inserted and
torqued to 35 N/Cm, and
the screw access hole was sealed with Teflon tape and a composite
restoration. The final clinical, periapical radiographic, and post-
operative CBCT evaluation revealed a pleasing and esthetic restor-
ative outcomewith stable peri-implant soft andhard tissues precisely
Fig. 26: Screw-retained
provisional restoration
Fig. 27: Screw-retained
provisional restoration
after reduction of
TiBase shoulder
diameter
Figs. 28-29: Clinical view (left) and periapical radiograph (right) of provisional
Fig. 30: Clinical view two months post implant surgery and
provisionalization
Fig. 31: Final screw-retained
restoration with Straumann
Variobase for CEREC
