CAD0111

Figs. 15 & 16_A surgical template in combination with a specifically matched surgical kit allowed for exact transfer of the 3-D computer planning to the patient’s mouth. Fig. 17_Fixed temporary bridges. Figs. 18a & b_The terminal molars (teeth #36 and 46) were fabricated as titanium single tooth crowns and screw-retained at implant level. Fig. 19_Distal-splinting in the lower jaw. Fig. 20_The Procera Implant Bridge Titanium on multi-unit abutments was veneered completely, including gingival regions, using VITA titanium ceramic. 34 I I industry report _ navigated implant placement CAD/CAM 1_2011 _very high quality milled titanium material; _no problems with chipping; _bridges are aesthetically pleasing and easy to remove; and _no gingival irritation is caused by a cement gap, since there is no such gap (Fig. 9). Screw-retained bridges and milled titanium are very popular forms of management today. Their production in the dental laboratory is no longer fraughtwiththeearlierdifficultiesofcasttitanium restorations, such as an alpha case layer. Accord- ingly, the veneering with titanium ceramic materi- als, made by VITA in the present case, has become muchsimpler.Inatemplate-guidedimplantplace- ment procedure, the axes are aligned such that the screw retentions can be implemented later exactly according to plan. This makes the work much easier and improves the quality of the re- storations. Consequently, implant restorations can be achieved that are attractive to the patient owing to their reasonable pricing and high quality aesthetic appearance. In this case, the master impression was taken during the surgical session. With respect to the skull, the models were mounted in an articulator by means of face-bow transfer via the impres- sion posts. The natural teeth were treated with NobelProcera Crowns Alumina, which is another CAD/CAM-based method for fabricating all- ceramic dental restorations. For this purpose, a framework coping and the implant frameworks were tried-in at the subsequent session. At the thirdsessionalready,thetooth-bornecrownswere incorporated and the finished implant bridges were tried-in during the same session. The defini- tiveincorporationofthefinalrestorationwasonly effected after a healing time of three months though. Owing to this specific surgical and pros- thetic protocol, no additional session for try-in was required, which the patient considered very convenient (Fig. 10). _Case II: Management of upper and lower jaw Itwaseasytoconcludefromtheinitialsituation of this case that the patient, a 63-year-old male, had eschewed visiting a dentist for a long time. Accordingly, the teeth were in need of much dental work(Fig.11).Followingacomprehensivediagnos- tic work-up, all teeth had to be removed, since they could not be conserved (Fig. 12). The patient was phobic and well aware of the poor condition of his teethbuthadnotperceivedanadequatetreatment option for his needs in the past. Talking to an ac- quaintance, he had been made aware of the avail- abilityofsurgerywithatemplatewithout“cutting” and detailed pre-surgical planning on a PC in order to minimise the attendant risks. By his own account, he would not have made the decision to haveclassicalsurgery.Forthesurgeon,theoutcome obtained in this case would not have been possible withoutthistechniqueexceptwithmuchdifficulty and significantly more surgical effort and trauma. Procedureaccordingtotreatmentplan It is very convenient for the treatment team to be able to proceed according to a detailed plan. Each member of the team is aware of all tasks and Fig. 18a Fig. 18b Fig. 15 Fig. 16 Fig. 17 Fig. 19 Fig. 20