Case 162 | The Award 2017 | Sweden
Fredrik Oxby DDS, Johan Oxby BDSc
There is always a challenge in a dental team as both a dental technician and a dentist to work in the esthetical zone. Remember that we are working at a daily basis to recreate the natural anatomy and working in conjunction with biology and in the end, create harmony, esthetics and functionality for the patient.
We received the patient in our care due to frontal blunt force trauma. Patient had fractures on the front incisors. When pain over the incisors area would not recede over time the decision was made to endodontically treat both 11 and 21. The initial plan was to keep both teeth and do conventional crown treatment. Upon further inspection, apparently both teeth had vertical root fractures which made the treatment plan with crowns impossible. The endodontic treatment was carried out to save the crestal bone due to risk of infection in and around the teeth. The treatment plan was extended to extract both teeth and do a direct installation of two implants in the 11 and 21 sockets. Two implants placed besides each other are very challenging since you risk losing the midline papillae.
Careful planning of the treatment was made in cooperation with both the dentist and the dental technician to accommodate the patient’s high expectations due to the trauma being in the esthetical zone. The plan was initially made to install an implant bridge over 11 and 21 but was changed to single tooth restorations. Extended healing time was accommodated to ensure proper stability was achieved for the permanent restorations.
After careful planning of the case, a decision was made to create a cement retained restoration on both 11 and 21. The abutments used a titan base, with a zirconia core. To complete the work, crowns were produced as fully anatomical IPS e.max CAD.
The first problem to solve was digital. Lack of the requested implant in the digital implant library required us to create a new digital analogue and triangulate with the rest of the Tibase components.
Under normal circumstances the workflow is as much as possible fully digital, with an intraoral scanner. Due to the lack of replica for a 3d printed model for the specific implant a plaster model was made and sectioned. The silicon gingiva where adapted for a good emergency profile.
The working plaster model and the antagonist, was then scanned in the 3shape Trios intraoral scanner to preserve the emergency profile from the silicon gingiva on the plaster model.
The zirconia core was designed and then milled in a Wieland select milling machine. The core of the zirconia was sintered and then adapted individually to a Tibase abutment creating a foundation for a cement retained restoration. The Tibase and the zirconia core were cemented. The plaster model was at this stage scanned in the laboratory using the 3shape Dental Lab scanner. The crowns were milled in an authorized machine for e.max CAD from Wieland Ivoclar.
The crowns where then stained and glazed for the finishing touch and then delivered to the dentist. The materials and helping aids:
Wieland Zenostar T Zirconia, Tibases Elos Medtech, IPS e.max Cad Ivoclar. Multilink Hybrid abutment. 3shape dentalmanager, 3shape D700, 3shape TRIOS, Wieland Select, scan bodies Elos Medtech, Astra Tech, Dentsply Implants.
Centre for Implant Dentistry, Tandvårdsgruppen & TVG Dentalteknik, Valbogatan 52, SE453 34 Lysekil, Sweden. Webbpage: tvg.nu
Corresponding Authors: firstname.lastname@example.org, email@example.com
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