45 year-old male patient admitted to our clinic for the loss of mandibular left first molar. A clinical and radiagraphic examination was made and an implant treatment was decided for the edentulous space. A Mode Rapid implant with 4.7mm diameter was placed.
3 months after implant surgery, a digital treatment approach was conducted for the screw retained crown prosthetic treatment (Figure 1,2).
Mode scan post and scan body were placed in the mouth for digital impression (Figure 3). A digital impression was taken by using Sirona Cerec AC Omnicam oral scanner (Figure 4).
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At this stage, the guide lines on the scan post and scan body were checked to be properly aligned (Figure 5).
Following digital impression, the crown was designed using Dentsply-Sirona inLab software (Figure 6,7).
The software automatically transferred screw’s path of insertion to the design and made it ready for milling (Figure 8).
The crown was milled from an IPS e.max CAD lithium disilicate block with Sirona CEREC MC XL dental miling machine (Figure 9).
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The milled and polished crown was cemented to ti-base abutment with Ivoclar Multilink Hybrid Abutment resin cement in laboratory.
Excess cement was cleaned and cementation area was polished in order to make a smooth finish (Figure 10,11).
The finished one piece crown was placed in mouth and the abutment screw was tightened with 25N/cm2 torque value (Figure 12).
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The screw opening was filled with teflon strip and sealed with light-cure composite resin (Figure 13).
Occlusion was checked again during centric and eccentric movements. After necessary adjustments were made, the screw retained crown was delivered to the patient (Figure 14,15).
In recent years, the use of digital methods in dentistry significantly increased globally. With current technology, it is possible to take a digital impression a patient and deliver restorations within the same day by using computer aided design/computer aided manufacturing technology. Digital workflow can be obtained either by taking digital impressions with an oral scanner or by taking conventional impressions and then scanning stone casts. With the help of these techniques, we can both save time and by taking more detailed impressions, we can make more accurately fitting restorations. In this case-report, the production of a screw retained implant supported crown was described.
OCCLUSION IN IMPLANT DENTISTRY
Occlusion concept in implant prosthetics, the importance of occlusion for long-term success, noteworthy issues for partially and complete edentulous arches
- Basics of implantology- Treatment planning principles
- Hybrid prostheses
- Treatment planning in implant overdentures
- Implant protective occlusion
- Force factors in fixed and removable implant dentures
- Key implant positions
- Occlusion concept for implant prosthetics
- The importance of occlusion for long-term success
- Impression techniques (closed, open, digital)
Learning outcomes
- Basic knowlegde about prosthetic implant planning and frequently made mistakes
- The importance of correct occlusal contacts for long-term success
- Details of impression taking with hands-on training
Motto: Precise and successful treatment can be achieved through pre-surgery planning.
Case report:
Patient description: 49 year-old male patient
Dental History: During clinical and radiographic examination it was observed that his right central incisor has internal resorption. An atrumatic extraction and immediate implantation was planned (Figure 1,2). Following implant surgery, impresion was taken immediately. An acrylic screw-retained provisional crown was fabricated and implemented in 24 hours after surgery (Figure 3,4,5). The provisional crown’s occlusion was adjusted in order to remove any contacts with the opposing teeth during centric occlusion and excursive movements. Although it was not esthetically ideal, this occlusal concept was adopted in order not to impede osseointegration. Follow-up examinations were made on first and second weeks, then monthly for 4 months (Figure 5,6,7). After 4 months, the patient received his permanent metal- ceramic crown (Figure 8).
#1 Initial panoramic x-ray
#2 Oral appearance on first visit
#3 Acrylic provisional crown
#4 Acrylic crown in-situ
#5 First week follow-up
#6 Third month follow-up
#7 Third month follow-up x-ray
#8 Final restoration and smile line