Listing for Topics: CAD/CAM

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Guide for Digitally Fabricated Crowns

Posted on in Integrated Abutment Crowns™

The fabrication of a digital crown for a Bicon implant begins by achieving a digital image of a virtual or tangible prosthetic model with a Bicon Implant Analog or Universal Abutment Transfer Die. The model can be achieved digitally by the preferred method of intraorally scanning a 2.0mm, 2.5 mm, or 3.0mm white Scan Post seated in the well of an implant. The following link provides a video with an explanation of the clinical techniques for intraoral scanning using a Scan Post, as well as making implant-level and abutment-level conventional transfer impressions: VIDEO » Immediate Placement and Restoration of a Maxillary First Molar with an Extra-Orally Cemented Lithium Disilicate Crown

[1-9] Once the digital scan file has been secured and entered into either the 3Shape or exocad design software, the appropriate Universal Abutment file can be selected from the CAD software’s digital abutment library to commence the designing of the crown.

[10-13] When designing, be cognizant of the minimum dimensions indicated by the intended material’s manufacturer, as well as their recommended post-milling treatment of their material. The designed STL file can then be sent to a milling machine for fabrication.

[14-17] Commonly used materials for digital crowns are Hybrid Ceramics, such as Enamic by Vita, Shofu Block HC Hard by Shofu, IPS e.max (a lithium disilicate ceramic), and Zirconia. Although a crown may be fabricated without a physical model, it may be more practical for those unfamiliar with digital dentistry to have a physical model to facilitate their confirming or adjusting the crown’s interproximal and occlusal contacts.

[18-19] Our preference is to use the Shofu Block HC Hard, since it can be readily modified chairside, either by reduction or addition, on the day of its insertion or any day, even years into the future. Additionally, it can withstand forces of shear, whereas the other materials do not provide for these clinical capabilities. The Shofu Block HC Hard is currently available in three shades (A2LT, A3.5LT, A4LT) and the following three sizes: Small (10.0mm x 12.0mm x 16.0mm), Medium (12.0mm x 14.0mm x 18.0mm), and Large (14.5mm x 14.5mm x 18.0mm).

[20-28] Additionally, our preference is to bond and to extraorally cement a CAD/CAM crown to a modified or unmodified Universal Abutment with resin cement for insertion as a single unit.

[29-39] After removing the extraneous resin cement from the Universal Abutment and removing the Temporary Abutment from the well of the implant, the Universal Abutment with the extraorally cemented CAD/CAM crown is placed into the well of the implant. Once the restoration is initially positioned, the patient may seat it by applying occlusal pressure with a cotton swab. Alternatively, the crown could be seated with a gentle tap. After confirming the appropriateness of the interproximal and occlusal contacts, a radiograph should be taken to complete the treatment.

[40-45] Rather than intraoral scanning, an implant-level conventional transfer impression may be made with a titanium Impression Post and a plastic Impression Sleeve.

[46-51] A third way to intraorally record an impression is to make an abutment-level conventional transfer impression, which utilizes a Universal Abutment and plastic Abutment-level Impression Sleeve. A fourth way is to scan the actual abutment intraorally.

Subsequently, physical impressions can be poured into stone with a titanium Implant Analog or a Universal Abutment Transfer Die, or digitally scanned for the printing of an actual physical model. The poured or printed model with an Implant Analog or a Universal Abutment Transfer Die may be digitally scanned to achieve a digital image of the abutment and prosthetic model. The digital scanning of an actual abutment, preferably a modified or unmodified Universal Abutment, is less desirable but still a feasible option. The abutment should have the widest diameter to fill the mesiodistal edentulous space without encroaching upon the adjacent interdental papillae.

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Fabrication of a Maxillary Telescopic TRINIA® Prosthesis and a Mandibular TRINIA® Overdenture and the Subsequent Conversion of the Mandibular Brevis™ O-Ring Overdenture to a Telescopic Prosthesis After One Year in Function

Posted on in Overdentures, Restorative, SHORT® Implants, Telescopic Restorations

This treatment of a seventy-five-year-old woman, who was previously told by six clinicians that dental implants would be an impossible treatment option (despite the fact that one clinician augmented her right maxilla with graft material), clearly demonstrates the unmatched clinical capabilities of Bicon SHORT® Implants and TRINIA® metal-free CAD/CAM material. The surgical placement of two maxillary and two mandibular implants is also shown, as well as the initial prosthetic restoration of a maxillary telescopic prosthesis and a mandibular Brevis™ O-Ring-retained mandibular overdenture, and the clinical and laboratory techniques for modifying and converting the mandibular Brevis™ O-Ring overdenture to a full-arch telescopic TRINIA® prosthesis after one year in function.

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Clinical Techniques for Fabricating and Inserting Maxillary and Mandibular Telescopic TRINIA® Prostheses with Universal Abutment Copings on Bicon SHORT® Implants

Posted on in Overdentures, Restorative, SHORT® Implants

This treatment demonstrates the clinical techniques for fabricating and inserting maxillary and mandibular telescopic TRINIA® prostheses with Universal Abutment copings each supported by two 4.5 x 8.0mm and two 5.0 x 6.0mm Bicon SHORT® Implants for a sixty-eight-year-old male patient.

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Placement of Three 4.5 x 6.0mm Bicon SHORT® Implants, Grafting with SynthoGraft™ and Collagen Membranes, Insertion of Three CAD/CAM Integrated Abutment Crowns™ (IACs), and Papillae Improvement

Posted on in Integrated Abutment Crowns™, Restorative, SHORT® Implants, Surgical, Two Stage, Uncovering

This treatment demonstrates the placement of three maxillary 4.5 x 6.0mm Bicon SHORT® Implants using SynthoGraft™ and two collagen membranes to graft a significant bony defect. The uncovering of the implants and the making of an implant-level transfer impression, as well as the insertion of three CAD/CAM Integrated Abutment Crowns (IACs) are also shown. Note the dramatic improvement of the papillae over a short period of time.

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Replacement of 25-Year-Old Maxillary and Mandibular O-Ring Relined Overdentures with Telescopic TRINIA® Prostheses

Posted on in Overdentures, Restorative, Telescopic Restorations

This case demonstrates the clinical and laboratory techniques and procedures for the replacement of two twenty-five-year-old tissue-borne overdentures with a telescopic maxillary implant-borne prosthesis on four implants and a telescopic mandibular implant-borne prosthesis on only two implants with 24mm and 21mm cantilevers.

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Replacement of an O-ring Mandibular Overdenture with a Telescopic TRINIA®-HC Prosthesis Utilizing Gothic Arch Occlusal Registration Tracing

Posted on in Overdentures

This case demonstrates the clinical and laboratory procedures and techniques to replace a 10-year-old O-Ring mandibular overdenture on three O-Ring Abutments with a telescopic prosthesis of TRINIA® and Shofu disc HC, CAD/CAM material, with three milled retentive copings on Universal Abutments in two clinical visits for a 75-year-old woman.

During the first clinical visit, the three O-Ring Abutments were removed from their implants, and three 2.0mm impression posts and corresponding acrylic sleeves were inserted for the making of a full arch implant-level transfer impression. An initial centric occlusal registration was recorded using modified acrylic impression sleeves at the patient’s existing vertical dimension of occlusion with the bite registration material, Capture. While the patient waited, the impressions were poured and the stone models articulated for the fabrication of a maxillary stylus and mandibular tracing plate to facilitate the registration of the patient’s centric relation utilizing the Gothic arch occlusal registration tracing. After recording the patient’s centric relation, the O-Ring Abutments were re-inserted, and the occlusal registration was sent to the dental technician for the fabrication of a telescopic TRINIA® substructure to which three separately milled teeth arrangements of Shofu disc HC material were bonded.

During the second clinical visit, the O-Ring Abutments were removed, and three Universal Abutments were inserted into the implants utilizing a light-cured resin orientation/seating jig, prior to the cementation of three milled retentive copings into the bores of the TRINIA®-HC prosthesis.

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Guided Placement and Restoration of a 5.0 x 6.0mm Bicon SHORT® Implant with a CEREC® e.max® CAD/CAM Crown

Posted on in SHORT® Implants

This case demonstrates the successful guided placement of a 5.0 x 6.0mm Bicon SHORT® Implant on a 67-year-old female and its restoration with a CEREC® chairside-designed e.max® abutment crown. A pre-op CEREC® designed crown integrated into an XG3D cone beam computed tomography (CBCT) was utilized for implant planning down the long axis of the CEREC® designed crown. The final design was emailed to SiCat for construction of a surgical guide with a Bicon Guided Sleeve. The guided surgery used the final desired intraoral position of the CEREC® abutment crown to determine the final position of the Bicon implant.

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Guided Placement and Restoration of a Missing Second Molar with a 5.0 x 6.0mm Bicon SHORT® Implant and a CEREC® e.max® CAD/CAM Crown

Posted on in SHORT® Implants

Radiographic and clinical images of this case demonstrate the successful guided placement of a 5.0 x 6.0mm Bicon SHORT® Implant on a 63-year-old female and restoration with a CEREC® chairside-designed e.max® abutment crown. The case utilized a pre-op CEREC® designed crown integrated into an XG3D cone beam computed tomography (CBCT) for implant planning down the long axis of the CEREC® designed crown. The final design was emailed to SiCat for construction of a surgical guide with a Bicon Guided Sleeve. This case illustrates guided surgery utilizing the final desired intraoral position of the CEREC® abutment crown to determine the final position of the Bicon implant.

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Insertion of a Fixed Telescopic TRINIA™ CAD/CAM Prosthesis

Posted on in Fixed, Restorative, Telescopic Restorations

This case demonstrates the cementation of four telescopic copings into a full-arch maxillary TRINIA™ CAD/CAM prosthesis and its insertion onto four Bicon abutments. The telescopic copings, which are bonded to the prosthesis via Ceraresin® Bond (CRB) by Shofu, are used to realign the abutments to better fit the bores of the prosthesis for both comfort and effective use.

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Two Stage Placement, Uncovering and Restoration of a Maxillary Left Central Incisor Using a Zirconia CAD/CAM Coping Cemented to an Abutment and e.max® Crown

Posted on in Surgical, Two Stage, Uncovering

This case demonstrates the extraction, two-stage placement of a 4.0 x 8.0mm implant with 2.5mm well, its uncovering, implant-level transfer impression, and restoration of a maxillary left central incisor using a zirconia CAD/CAM coping cemented to an abutment and e.max® crown.