Implant Tribune Canada No. 3, 2014
Implant site preservation using novel post and crown / Préservation du site implantaire avec une couronne/pilier hybride
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IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · Canada Edition
MAY/Mai 2014 — Vol. 2, No. 3
www.dental-tribune.com
Industry Clinical, Part 1 / Clinique de l’industrie, Partie 1
Implant site preservation using
novel post and crown
By Les Kalman, DDS, BSc (Hon)
Abstract
Implant site preservation is an important
component of diagnosis and treatment
planning. Through computer-aided design
(CAD), prosthesis can be designed with
ideal characteristics. By utilizing computeraided manufacturing (CAM), the clinician
has the ability to mill the designed prosthesis with great accuracy.
IPS e.max has been selected as the material for this investigation because of its
strength and esthetics. The combination of
IPS e.max and in-office CAD/CAM technology allows the clinician the ability to create
an esthetic and predictable moderate-term
provisional to preserve a site for future implant placement.
Introduction
Implant placement in the esthetic zone is
the ideal treatment option when diagnostic criteria are satisfied.1 Finances, however,
can act as a barrier to treatment.
A moderate-term, esthetic provisional
would allow the patient the opportunity
to overcome barriers. In-office CAD/CAM
technology would allow for immediate
prosthesis fabrication.
CAD allows the clinician to digitally capture an image of a preparation and then design an indirect (out of the mouth) restoration by using software.2
After the ideal restoration has been produced, the design is then fabricated out of
a material by a milling machine. E4D is an
in-office dental unit (E4D Technologies). IPS
e.max is a metal-free, esthetic dental material used in indirect restorations.
IPS e.max is composed of lithium disilicate, and its ideal physical and esthetic
properties allow it to be the first choice for
CAD/CAM restorations.3 IPS e.max has the
ability of detailed CAM production and has
strength second only to gold.3
Clinical case presentation
A 28-year-old male patient presented with
a failed post and core and porcelain-fusedto-metal (PFM) crown. His chief complaint
was that the “fake tooth” had become dislodged several times and he requested a
long-term solution.
Medical history was non-contributory.
Clinical and radiographic examination
indicated an endodontically treated central incisor with no apical pathology and a
failed post and core/crown restoration. The
PFM crown was still cemented to the post
and core and lacked a ferrule effect. The
post and core/crown had been recemented
several times in the past.
Diagnosis indicated endodontic treatment, failed post and core, and caries on
tooth #11. Treatment options to replace the
missing tooth included an implant supported crown, a bridge, a removable partial denture or no treatment. The patient
had interest in the implant option but requested that the old unit be re-cemented.
He had several professional and personal
obligations that required an esthetic provisional. Finances were a limiting factor. The
existing post and core/crown was deemed
poor and could not be used.
Based on the situation, an alternative
option was presented to the patient: an indirect IPS e.max CAD/CAM post and core/
crown moderate-term provisional that
would be fabricated using an in-office E4D
unit. Treatment-specific informed consent
was given, and the patient agreed. It was
decided to generate an indirect CAD/CAM
prosthesis because of the investigative nature of the clinical case.
” See NOVEL, page B2
• Fig. 1: Preparation of tooth #11 and use of
paper clip. Photos/Provided by Dr. Les Kalman
• Fig. 1: Préparation de la dent #11 et
l’utilisation d’un trombone Photos/Fournies
par Dr. Les Kalman
• Fig. 2: Segmental Q-tray impression.
• Fig. 2: Empreinte avec Q-tray segmenté.
Préservation du site implantaire
avec une couronne/pilier hybride
Par Les Kalman , DDS , BSc ( Hon)
Résumé
La préservation du site post-extractif est
une composante importante du diagnostic et de la planification du traitement. Des
prothèses aux caractéristiques idéales peuvent être conçues par la Conception Assistée
par Ordinateur (CAO). De plus, en utilisant le
procédé de Fabrication Assistée par Ordinateur (FAO), le clinicien possède la capacité
de meuler la prothèse avec grande exactitude. Le IPS e.max a été choisi pour cette
investigation à cause de sa force et de son
esthétisme. La combinaison du IPS e.max
et l’utilisation de la technologie CFAO en
bureau donnent au clinicien la capacité de
réaliser de façon prévisible une restauration
temporaire de moyen terme afin de préserver le site post-extractif.
Introduction
Placer des implants dans la zone dite esthétique est le traitement idéal lorsque les
critères diagnostics sont satisfaits.1 Cependant, le budget peut être un empêchement
aux traitements. Une restauration esthétique temporaire de moyen terme peut
permettre au patient de passer outre cette
barrière. La technologie en bureau CFAO
permettrait une fabrication immédiate de
la prothèse.
La CAO permet la capture numérique
d’une image de la préparation pour ensuite
concevoir à l’aide d’un logiciel une restauration indirecte (en dehors de la bouche).2
Après que la restauration idéale est conçue,
la fabrication est complétée en vitrocéramique par un appareil de meulage. E4D
est un appareil dentaire pour le bureau (E4D
Technologies).
IPS e.max est un produit dentaire esthétique sans métal utilisé pour les restaurations indirectes. Le IPS e.max est composé
de disilicate de lithium et ses propriétés physiques et esthétiques idéales en font le premier choix pour les restaurations par CFAO.3
Avec une résistance juste en dessous de celle
de l’or, le IPS e.max possède la capacité de
Les Kalman, DDS, BSc (hon), has served as the chief of dentistry at the StrathroyMiddlesex General Hospital. In 2011, he transitioned to full-time academics as an assistant professor of restorative dentistry at the Schulich School of Medicine and
Dentistry, University of Western Ontario. Kalman is also the coordinator of the Dental Outreach Community Services (DOCS) program, which provides free dentistry
within the community. Contact him at (519) 661-2111, ext. 86097 or lkalman@uwo.ca.
Les Kalman, DDS, BSc (Hon), occupait le poste de chef de la dentisterie au Strathroy-Middlesex General
Hospital. En 2011, il se dirigea dans le milieu universitaire à plein temps en tant qu’aide-professeur à la Schulich
School of Medicine and Dentistry. Kalman est aussi le coordinateur du programme pour les Services de Dentisterie Communautaires (DOCS) qui fournit de la dentisterie gratuitement dans la communauté. Vous pouvez le
détail requise pour la production par FAO.3
Présentation d’un cas clinique
Un patient mâle de 28 ans présentant un
tenon radiculaire coulé défectueux avec
une restauration céramo-métallique (PFM).
Sa plainte principale était que la fausse dent
s’était déplacée à plusieurs reprises et qu’il
désirait une solution à long terme. Nous
n’avons pas tenu compte de l’historique médical. L’examen clinique et radiologique ont
indiqué un traitement d’endodontie sur une
incisive centrale sans pathologie apicale,
ainsi qu’une rupture au niveau de la restauration couronne/tenon radiculaire coulé.
La restauration céramo-métallique était
toujours cimentée au tenon radiculaire
coulé, mais sans l’effet de fer désiré. La restauration céramo-métallique et le tenon
radiculaire coulé avaient été cimentés à plusieurs reprises dans le passé. Le diagnostic
indiquait un traitement d’endodontie, une
rupture du tenon radiculaire coulé et une
carie sur la dent #11. Les options de traitement pour remplacer la dent manquante
étaient soit une couronne sur implant, soit
un pont fixe, soit une prothèse amovible
ou aucun traitement. Le patient avait de
l’intérêt pour la pose d’un implant, mais
demanda que la vieille restauration soit cimentée de nouveau.
Le budget était une restriction au traitement et ayant plusieurs obligations personnelles et professionnelles, ce cas nécessitait
un traitement provisoire. Le tenon radiculaire coulé fut jugé inutilisable et ne pouvait
servir de nouveau. Basé sur la situation du
patient, une alternative lui a été présentée
contacter à la Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1,
(519) 661-2111, ext. 86097, lkalman@uwo.ca.
” Voir HYBRIDE, page B2
[2] =>
B2
“ NOVEL, page B1
Preparation
Tooth #11: The canal space was cleaned of
cement and the remaining tooth structure was prepared as per full porcelain
coverage specifications. A paper clip was
inserted into the canal space (Fig. 1). A
XXXXX
INDUSTRY CLINICAL/CLINIQUE
DE L’INDUSTRIE
final PVS impression (Ivoclar) was taken
using a Q-Trays (Research Driven) segmental tray (Fig. 2). A bite registration
was taken for the CAD/CAM scan. The patient was dismissed to the waiting room
while the prosthesis was fabricated.
Editor’s Notes: In Part 2, Kalman covers
the indirect CAD/CAM component, discus-
“ HYBRIDE, page B1
Préparation
: une restauration couronne/pilier hybride
esthétique temporaire de moyen terme,
utilisant le IPS e.max et la CFAO qui pourrait
être fabriquée en bureau avec l’unité E4D.
Afin d’obtenir un consentement éclairé, les
données particulières au traitement ont été
données au patient. Une fois cette option
acceptée, on créa une prothèse indirecte par
CFAO due à la nature de l’enquête du cas
clinique.
Dent #11: L’espace du canal a été nettoyé des
résidus de ciment et la structure restante de
la dent a été préparée d’après les spécifications pour une couverture complète avec
de la porcelaine (Fig. 1). Un trombone a été
inséré dans le canal (Fig. 2). Une impression
finale VPS (Ivoclar) a été prise utilisant un
porte empreinte Q-Tray segmenté (Research
Driven) (Figs. 3–5). L’enregistrement occlusal
a été pris pour le scanneur de la CFAO (Fig.
6). Le patient retourna à la salle d’attente
Ad
Implant Tribune Canada Edition | May/Mai 2014
sion and conclusions.
This article is reprinted from Implants
C.E. magazine, Volume 2, Issue 2, 2013.
Disclosure: Dr. Les Kalman is the coowner of Research Driven and the developer of the Q-Tray.
References available from the publisher
on request.
IMPLANT TRIBUNE
Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com
Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Kristine Colker k.colker@dental-tribune.com
pendant la fabrication de la prothèse.
Notes du rédacteur : Dans la partie 2, Kalman traite des composantes indirectes de la
CFAO, discussions et conclusions.
Cet article est une réimpression de : Implants C.E. magazine, Volume 2, Issue 2,
2013.
Divulgation : Dr Les Kalman est copropriétaire de Research Driven et le développeur du Q-Tray.
Références disponibles de l’éditeur sur
demande.
Managing Editor Implant Tribune Canada
Robert Selleck, r.selleck@dental-tribune.com
Managing Editor Implant Tribune U.S.
Sierra Rendon s.rendon@dental-tribune.com
Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product/Account Manager
Will Kenyon w.kenyon@dental-tribune.com
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
PRODUCT/ACCOUNT MANAGER
Drew Thornley d.thornley@dental-tribune.com
Marketing DIRECTOR
Anna Kataoka
a.kataoka@dental-tribune.com
Education Director
Christiane Ferret c.ferret@dtstudyclub.com
Accounting Coordinator
Nirmala Singh n.singh@dental-tribune.com
Projects & Events Coordinator
Robert Alvarez r.alvarez@dental-tribune.com
Tribune America, LLC
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2014 Tribune America, LLC
All rights reserved.
Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you find a
factual error or content that requires clarification,
please contact Managing Editor Robert Selleck at
r.selleck@dental-tribune.com.
Tribune America cannot assume responsibility for
the validity of product claims or for typographical
errors. The publisher also does not assume responsibility for product names or statements made by
advertisers. Opinions expressed by authors are their
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Editorial Board
Dr. Pankaj Singh
Dr. Bernard Touati
Dr. Jack T. Krauser
Dr. Andre Saadoun
Dr. Gary Henkel
Dr. Doug Deporter
Dr. Michael Norton
Dr. Ken Serota
Dr. Axel Zoellner
Dr. Glen Liddelow
Dr. Marius Steigmann
Corrections
Implant Tribune strives to maintain the
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, report
the details to managing editor Robert
Selleck, r.selleck@dental-tribune .com.
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