28 STARGET 3 I 09

CLINICAL CASES

Esthetic restoration of a Straumann RC Bone Level Implant with a CADCAM ceramic abutment
by Raymond Dubs, Dental Technician and Dr med. dent. Rudolf Auer

Fig. 1: Model with gingival mask ready for modeling.

Fig. 2: Diagnostic modeling in wax of tooth 21.

Fig. 3: Pliable silicone index, labial.

Initial situation The middle-aged patient had lost tooth 21 following an accident. On examination, the anterior maxillary area was caries-free. The patient and dentist opted for implantation of a Straumann RC Bone Level Implant ( 4.1 mm, SLActive).

Procedure After the implant healing phase, the dentist took an impression with a custom open tray. This was sent to the dental laboratory, where a precise master model with removable gingival mask was made (Fig. 1). Since the gap was about 1.5 mm narrower than the homologous tooth, a wax-up was made first in order to examine the situation for the final restoration (Fig. 2).

The wax-up showed a satisfactory situation so that an index could now be made from the labial side with pliable silicone (Fig. 3). A RC wax-up sleeve was placed in the master model analog and the shape of the mesostructure was modeled with Scan wax (etkon CopyCad) (Fig. 4). The dimension of the waxed-up abutment was checked with the index made previously of pliable silicone (Fig. 5).

CLINICAL CASES

STARGET 3 I 09 29

Fig. 4: Wax modeling on wax-up sleeve, labial view.

Fig. 5: Wax modeling on wax-up sleeve with index, labial view.

Fig. 6: Wax modeling on the wax-up sleeve holder in scan cylinder no. 7, ready for scanning.

Fig. 7: Finished CADCAM zirconia abutment from labial aspect.

Fig. 8: Finished CADCAM zirconia abutment from palatal aspect.

Fig. 9: Placement aid for the dentist.

The abutment modeled from wax was then positioned in the RC wax-up sleeve holder and this was placed in scan cylinder no. 7 of the etkon es1 scanner (Fig. 6). After the modeled abutment was scanned by the etkon es 1 scanner, the design could be adjusted and optimized through various operating elements in the etkon_visual software. With a little experience, the scanning and processing takes only a few moments. The digital dataset of the customized abutment is then sent to the Straumann CADCAM production center via an Internet connection.

After a few working days, the CADCAM ceramic abutment fabricated in the Straumann production center is sent to the laboratory by post or directly by courier. It is there checked again for precise fit on the model before it is sent to the dentist for try-in (Figs. 7, 8). Together with the CADCAM ceramic abutment, the dentist was supplied with an insertion aid made in the laboratory. The insertion aid is supported on the neighboring teeth and allows correct and simple positioning of the ceramic abutment in the implant (Figs. 9, 10).

At this point it is important to check the abutment with regard to support of the gingiva and the final crown margin. After the try-in at the dentists, the CADCAM ceramic abutment was sent back to the dental laboratory where the final restoration was made. To do this, the CADCAM ceramic abutment is positioned in the es1 scanner and scanned. A CADCAM cap made of zerion is then constructed in etkon_visual software. This is done without any wax-up. The zerion cap can be designed with simple operating elements exclusively on the screen. After finalizing the cap, it is ordered from the Straumann CADCAM milling center via the

30 STARGET 3 I 09

CLINICAL CASES

Fig. 10: CADCAM abutment in situ.

Fig. 11: Finalized zerion crown on the model.

10

11

Raymond Dubs
Dental Technician Fig. 12: Veneered zerion cap on CADCAM zirconia abutment in situ. Own dental laboratory in Kloten/ Switzerland, specializing in all-ceramic and zirconium oxide restorations, implant restorations and CADCAM prosthetics ITI member

Fig. 13: Final restoration.

Dr med. dent. Rudolf Auer

dr.auer@zam-sh.ch Practice in Schaffhausen/Switzerland
12 13

Member of SGI, SSOS, ZPGS, SSP ITI member

etkon_visual software. The cap is sent within a few working days to the laboratory by post or courier from central Straumann CADCAM production. The zerion cap is now veneered in the laboratory using the standard method. This is where the talents of the dental technician are needed as knowledge, experience and good observational ability are important requirements for successful ceramic work (Fig. 11).

Final restoration and conclusion The finalized veneered zerion cap was then sent to the dentist, who carried out the final implant restoration. The patient was provided with a completely natural-looking and high-quality single tooth restoration using a Straumann Bone Level Implant and CADCAM-fabricated ceramic prosthesis (Figs. 12, 13).

Special interests: oral surgery, prosthetic reconstructions