CAD/CAM international No. 4, 2014
Cover
/ Editorial
/ Content
/ Designing real smiles with digital tools
/ Zirconia Reinforced Composite—a universally applicable material with many prosthetic uses
/ Permanent implant prostheses
/ Double crownsmade of a new high performance polymer
/ Implant-supported immediate restoration in the edentulous maxilla
/ Paving the way for a patient-friendly - minimally invasive approach in alveolar ridge augmentation
/ Planmeca ProMaxCBCT with CAD/CAM technology: the perfect combination
/ DENTSPLY Implants expands into new markets
/ 3Shape TRIOS recognised with “Best of Class” Technology Award
/ Adentatec Competence in Dental
/ One streamlined flow
/ International Events
/ Submission guidelines
/ Imprint
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Standard_300dpi
CAD0414_01_Title 17.11.14 12:10 Seite 1
issn 1616-7390
Vol. 5 • Issue 4/2014
CAD/CAM
digital dentistr y
international magazine of
4
2014
| special
Designing real smiles
with digital tools
| case report
Implant-supported immediate restoration
in the edentulous maxilla
| industry report
Zirconia Reinforced Composite
[2] =>
Standard_300dpi
The natural choice
ATLANTIS patient-specific abutments
™
DENTSPLY Implants does not waive any right to its trademarks by not using the symbols ® or ™. 32670183-USX-1312 © 2013 DENTSPLY Implants. All rights reserved
For all major
implant
systems
Give your patients excellent function and natural esthetics.
ATLANTIS patient-specific abutments go beyond CAD/CAM to deliver:
• Freedom of choice in implant system and material
• Optimal emergence profiles and soft tissue margins
• Anatomical support for the final restoration
• A simplified restorative procedure
To learn more about ATLANTIS patient-specific prosthetic solutions,
contact your local DENTSPLY Implants representative or visit our website.
We have you covered
ATLANTIS abutments are backed by a
comprehensive warranty program.
For full warranty terms and conditions,
visit www.atlantisdentsply.com.
ATLANTIS patient-specific abutment
Stock abutment
www.dentsplyimplants.com
32670183-USX-1311_ad_ATLANTIS Clinician_A4.indd 1
2014-01-08 13:55
[3] =>
Standard_300dpi
CAD0414_03_Editorial 14.11.14 13:33 Seite 1
editorial _ CAD/CAM
I
Dear Reader,
_Digital technology is one of the fastest-growing market segments in dentistry; digital
processes are increasingly determining everyday practice in dental offices and laboratories
and seem to be changing dentistry and dental market forever.
In recent years, an increasing number of dental companies have released innovations in
digital hardware, software and consumables, such as 3-D imaging, CAD/CAM and intra-oral
devices.
Torsten R. Oemus
As a response to the market needs Dental Tribune International (DTI) in collaboration with
Unione Nazionale Industrie Dentarie Italiane (UNIDI), the Italian dental industry association,
held the first Digital Dentistry Show (DDS) at the International Expodental in Milan. The event
was the first of its kind, being solely dedicated to digital dental technologies. Over the course
of three days, DTI and major industry partners offered visitors to the fair comprehensive information on the latest developments and product innovations in the field of digital technologies.
DDS provides comprehensive information on the latest digital technology and is targeted
at dentists, dental technicians and representatives of the dental industry. In contrast to the
conventional booth-based presentation of products, DDS is showcasing digital innovations
through a combination of sponsored live product presentations, hands-on workshops,
discussion sessions, an exhibition and a printed guide, offering participants a dynamic and
interactive education experience.
The next Digital Dentistry Show will be held in Rimini in Italy from 21 to 23 May 2015
as part of the Amici di Brugg dental trade fair. Moreover, we are planning to stage another
DDS in October 2015 in Shanghai. Plans are also underway for an international edition
of the show in Berlin in June 2016.
Digital dentistry is already here, technology is what differentiates a modern dental office
from a conventional one, increases patient flow, and advances diagnostic and treatment
outcomes, which ultimately leads to increased revenues.
Yours sincerely,
Torsten R. Oemus
President Dental Tribune International
CAD/CAM
4_ 2014
I 03
[4] =>
Standard_300dpi
CAD0414_04_Content 17.11.14 12:13 Seite 1
I content _ CAD/CAM
page 06
page 12
I editorial
I industry news
03
40
Dear Reader
| Torsten R. Oemus
page 20
Planmeca ProMax CBCT with CAD/CAM technology:
the perfect combination
| Planmeca
I special
06
42
| DENTSPLY Implants
Designing real smiles with digital tools
| Drs Eduardo Mahn, Gustavo Mahn, Carlos Cáceres,
Luis Bustos & Christian Coachman
44
Zirconia Reinforced Composite—a universally
applicable material with many prosthetic uses
45
46
I case report
Permanent implant prostheses
Double crowns made of a new high performance polymer
| Drs Rolf Vollmer, Martina Vollmer, ZTM Michael Anger
& Dr Rainer Valentin
32
One streamlined flow
| Nobel Biocare
| Drs Arzu Tuna, Umut Baysal & Rainer Valentin
20
Adentatec
Competence in Dental
| Adentatec
| Maximilian Kollmuß & Julia Goeke
16
3Shape TRIOS recognised with
“Best of Class” Technology Award
| 3Shape
I industry report
12
DENTSPLY Implants expands into new markets
Implant-supported immediate restoration
in the edentulous maxilla
I meetings
48
International Events
I about the publisher
49
| submission guidelines
50
| imprint
issn 1616-7390
Vol. 5 • Issue 4/2014
CAD/CAM
digital dentistry
international magazine of
4
2014
| Dr Fernando Rojas-Vizcaya
36
Paving the way for a patient-friendly, minimally invasive
approach in alveolar ridge augmentation
| Dr Yasmin Buchaeckert
4_ 2014
Designing real smiles
with digital tools
| case report
Implant-supported immediate restoration
in the edentulous maxilla
| industry report
Zirconia reinforced composite
Cover image courtesy of Adentatec GmbH (www.adentatec.com).
page 32
04 I CAD/CAM
| special
page 40
page 48
[5] =>
Standard_300dpi
More than efficiency.
Cost-effective
workflow solutions.
What does efficiency mean to your business?
ѹѹ Newly introduced one-step and cost-effective implant restorations, titanium base and full-contour crown were added to
Straumann® CARES® X-Stream™’s 1 scan, 1 design and 1 delivery
ѹѹ Directly veneerable TAN Abutment for a quick path to your
final restoration
ѹѹ New CARES® Screw-retained Bridges and Bars increase
treatment flexibility
ѹѹ Ability to connect your CADCAM system to Straumann®
CARES® Prosthetics – no additional investment or training
required, visit: www.straumann.com
Ad_Cares 8.8_A4_Vorlage.indd 1
01.04.14 10:26
[6] =>
Standard_300dpi
CAD0414_06-10_Mahn 14.11.14 13:34 Seite 1
I special _ digital smile design
Designing real smiles
with digital tools
Authors_Drs Eduardo Mahn, Gustavo Mahn, Carlos Cáceres, Luis Bustos, Chile & Christian Coachman, Brazil
have experienced major improvements in ceramics
and composites, helping us to fulfil our patients’
aesthetic demands.
Fig. 1
Fig. 2
_Dental materials and clinical procedures
have changed dramatically in the last decades.
Probably the major advances that have occurred
during the last two decades have been in the
fields of implantology and adhesive dentistry, but
the main revolution is the development of digital
dentistry. Although these changes have certainly
made diagnostics and certain procedures easier,
the basics, such as function and the biological
aspects, remain essential. At the same time, we
Fig. 3
06 I CAD/CAM
4_ 2014
A basic prerequisite for these indications is an
in-depth understanding of the facial and dental
aesthetic parameters. The clinician needs to understand the challenges that each clinical case presents
and has to be able to develop an appropriate treatment plan that approaches the case from a multidisciplinary perspective. Tooth proportions need to
be considered in relation to gingival aesthetics and
in relation to the facial appearance. It is pointless
to make the most beautiful direct veneer if the
contours or the texture do not match that of the
adjacent teeth or the gingival zeniths are clearly not
symmetric and visible. As an example, if we add
a tilted occlusal plane or a maxillary tooth midline
shift in relation to the facial midline, the results can
be frustrating.
Another important aspect is the proper analysis
of the patient’s smile and display (Figs. 1 & 2).
When photographs are taken, people tend to be shy,
especially at the beginning and even more so if the
person taking the photographs is not a professional
photographer and the setting is a dental practice.
Figure 3 shows the intra-oral view, where, besides
the obvious diastema and the hypomineralised
[7] =>
Standard_300dpi
CAD0414_06-10_Mahn 14.11.14 13:34 Seite 2
special _ digital smile design
I
Fig. 4
Fig. 5
areas of both central incisors, the major discoloured
areas of both mandibular lateral incisors, which
were certainly in need of some sort of treatment,
are apparent. It is important to try to make a video
while conversing with the patient about normal
daily issues to avoid overlooking aspects that need
to be considered in the treatment plan. The conversation will relax the patient and evoke natural smiles
and laughs in response to something humorous
or silly that we might say. Figure 4 shows the differences between the social smile we achieved with
our traditional photographs (Figs. 1 & 2) and the
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10a
Fig. 10b
Fig. 11
Fig. 12
Fig. 13
CAD/CAM
4_ 2014
I 07
[8] =>
Standard_300dpi
CAD0414_06-10_Mahn 14.11.14 13:34 Seite 3
I special _ digital smile design
(Figs. 6 & 7). The upper lip line is recreated and then superimposed on to
the photograph taken with lip retractors in place as reference of its position
(Figs. 8 & 9). Then the tooth proportions
are measured and their ideal contours
are drawn (Figs. 9 & 10a). The isolated
situation can be seen in Figure 10b.
A photograph taken from the 12 o’clock
position is used for the analysis of the
labio-palatal position of the teeth and
superimposed on to the analysis done
previously (Fig. 11).
Fig. 14
spontaneous smile, which was captured during
dynamic recording. In this particular clinical case,
had we based our treatment plan on the social smile
photograph, we would have failed to visualise the
display of the mandibular incisors, which showed
unpleasant stains.
The next step was to analyse the patient from the
facial perspective based on the details of her teeth.
The digital smile design (DSD) concept diagnoses
aesthetic problems from a facial perspective and,
based on a simplified digital analysis of a few photographs, proposes treatment options and assists
with communication between the various specialists in the team.
The first step is to draw a horizontal and a vertical
line. The photograph is centred, moved and rotated
until the bi-pupillary line is horizontal. The facial
midline is subsequently ascertained. Then the same
lines are superimposed on to a similar photograph,
which has also been centred, but this time taken
with lip retractors in place (Figs. 5a–c). The same
photographs are then magnified and analysed
Fig. 15
08 I CAD/CAM
4_ 2014
Once the clinician is clear about
the treatment possibilities and limitations, a digitally designed mock-up can be created.
This procedure reduces chair time dramatically
and increases patient acceptance. Owing to easily
accessible software such as Microsoft PowerPoint
and Keynote, these effects are easily and quickly
created by anyone with minimal training. Recently,
new software has been released that simplifies
the procedure even more, DSD software for iPads
(www.digitalsmiledesign.com). The procedure is
based on overlapping certain areas of the teeth in
the manner previously described. The result can be
seen in detail in Figure 12 and the display in Figure
13. A comparison from the facial perspective between the preoperative situation, the traditional
mock-up and the digital mock-up can be seen in
Figure 14. Traditional indirect mock-ups are made
from a previously created wax-up from the laboratory. First, an impression is taken and a stone cast
is then fabricated. Afterwards, the technician waxes
the necessary teeth depending on the instructions
given by the clinician.
The next step is taking an impression from that
wax-up. The excess is removed and a flowable selfor dual-curing composite material
(usually bis-acrylic based) is applied to
the silicone guide and then placed in
the patient’s mouth. After a few minutes, the excess is removed and the
patient is able to see the changes and
the clinician is able to evaluate the
proposal directly in the mouth. Generally, photographs are taken of the new
situation and analysed. The option of
a digital mock-up is much simpler.
Once the final forms have been created, a photograph is superimposed
on to them, and the texture of the new
teeth is created. As seen in Figure 14,
the results of the traditional and the
digital methods are similar and it is
difficult to differentiate between them.
[9] =>
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CAD0414_06-10_Mahn 14.11.14 13:34 Seite 4
special _ digital smile design
The protocol is based on photographs and
videos that are taken during the first appointment.
The analysis is performed, and eventually the case is
discussed with the team if necessary. Once the presentation is ready, the treatment plan is presented
in a visually attractive way to the patient (Fig. 15).
Finally, whether to use ceramic or composite restora tive materials is considered depending on different
factors. Our philosophy is based on the minimally
I
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
invasive concept. As long as we can provide the
patient with the same aesthetics, durability and
predictability of ceramics, we will select composites.
In cases in which many teeth are involved, multiple
diastemas are present or occlusal imbalances may
jeopardise a successful outcome and major changes
need to be made, our choice leans towards ceramics.
Whatever approach is chosen, it is of paramount importance for the clinician to understand the ceramic
Fig. 22
CAD/CAM
4_ 2014
I 09
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CAD0414_06-10_Mahn 14.11.14 13:34 Seite 5
I special _ digital smile design
Fig. 23
Fig. 24
Fig. 25
Fig. 26
and/or composite system he or she is using. In this
particular clinical case, the ceramic system used
was IPS e.max Press and the composite system was
IPS Empress Direct (both Ivoclar Vivadent) because
of its simple layering concept, its natural-looking
shades and long-lasting gloss. The correspondences
between the shades of both systems make them
easier to combine.
Once the treatment plan has been accepted by
the patient, the treatment begins with preparation
and demarcation in order to be as conservative
as possible (Fig. 16). Figure 17 shows the detail of the
hypomineralised areas of the mandibular lateral
incisors. The areas were excavated with a redcoloured bur (Komet Dental) and etched with phosphoric acid. ExciTE F (Ivoclar Vivadent) was used as
a bonding agent, and IPS Empress Direct Dentin A1
and Enamel A1 were placed using a novel instrument called OptraSculpt Pad (Ivoclar Vivadent).
The maxillary teeth were prepared and impressions taken. Figure 20 shows the six veneers fabricated by master dental technician Victor Romero
(Santiago, Chile). Then they were tried-in with a
specially designed glycerine-based paste, com ponents of the Variolink Esthetic cementation kit
(Ivoclar Vivadent). Figure 21 shows how dramatic
the change in value can be with this type of cement.
This procedure is especially helpful when one or two
veneers are seated, and the value needs to be slightly
corrected in order to match them to the adjacent
10 I CAD/CAM
4_ 2014
teeth. The veneers were then bonded and the final
result can be seen in Figure 22, where the preoperative situation is shown against the similar results
achieved with the digital mock-up compared with
the final outcome. Figures 23 and 24 show the integration of the six maxillary ceramic veneers and the
two direct composite restorations performed on the
mandibular lateral incisors at the three-month follow-up. All this work was integrated from the facial
perspective, as seen in Figure 25. The satisfied and
spontaneous patient can be observed in Figure 26._
_about the authors
CAD/CAM
Dr Eduardo Mahn, DDS, DMD, PhD, is a lecturer
at the Universidad de los Andes in Santiago, Chile.
Dr Gustavo Mahn, DDS, is a lecturer at
the university Finis Terrae in Santiago, Chile.
Dr Carlos Cáceres, DDS, is a lecturer at
Universidad del Desarrollo in Concepción, Chile.
Dr Luis Bustos, DDS, is a lecturer at Universidad
del Desarrollo in Concepción, Chile.
Dr Christian Coachman, DMD, MDT,
is in private practice in São Paulo in Brazil.
_contact: Dr Eduardo Mahn, emahn@miuandes.cl
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CAD0414_12-14_Kollmuss 17.11.14 12:13 Seite 1
I industry report _ CAD/CAM material
Zirconia Reinforced
Composite—a universally
applicable material with
many prosthetic uses
Authors_Maximilian Kollmuß & Julia Goeke, Germany
Fig. 1_Abrasion across
the whole dentition.
Fig. 2_Initial situation.
Fig. 1
Fig. 2
_Introduction
Fig. 3_Dental x-ray of region 15.
Fig. 4_Situation after
removing the old crown.
Fig. 5_Impression.
Fig. 3
CAD/CAM technology opens up a wider spectrum of new materials for use in dental prosthesis. For a long time, it was not possible to treat
Fig. 4
12 I CAD/CAM
4_ 2014
patients with distinctive bruxism with highly
aesthetic, tooth-coloured restorations. Extremely
sensitive ceramics posed a constant risk of fracturing under the strain of the high forces that
come with parafunctions.
Fig. 5
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industry report _ CAD/CAM material
I
This newly developed material is a combination of highly durable plastic and zirconium
dioxide, which principally combines the positive
features of both material groups: the acrylic content ensures a certain elasticity to the material
which ideally imitates the natural elasticity of
the periodontium. This is particularly beneficial
with implant treatments for ensuring an even
distribution of chewing forces. The addition
of zirconium dioxide improves the mechanical
strength of the restoration and ensures an
optimal abrasion stability without the risk of
exposing the antagonist to excessive forces.
Fig. 6
The case report presented in this article is
an example of the difficulties encountered when
treating patients suffering from parafunctions.
_Case report
The 55-year-old patient made a dental appointment, having noticed a sharp edge for quite
some time by his implant crown in the upper
jaw, region 15, which had been there for quite
some time. The clinical examination concluded
that there was a fracture in the metal-ceramic
implant‘s palatal veneering. Furthermore, the
patient appeared to have noticeable evidence of
grinding on the majority of teeth. When asked,
the patient admitted to grinding and pressing his
teeth, particularly at night.
Fig. 7
The implant had been inserted in July 2010
and indicated an inconspicuous percussive resonance with no signs of a peri-implant infection.
A x-ray was carried out as a safety precaution and
similarly showed no pathological findings.
a material better suited to the patient. At this
point, the option of a new, innovative material
came to mind: a highly durable acrylic, reinforced
with zirconium dioxide (Tizian Zirconia Reinforced
Composite, Schütz Dental).
Fig. 6_Scanned model
with simulated abutment.
Fig. 7_Finished crown
with antagonist construction.
It was discussed together with the patient
that a new implant crown should be fitted, using
After the fractured crown had been removed, the
situation was as follows with uninflamed mucosa:
Figs. 8 & 9_Finished restoration
on the master model.
Fig. 8
Fig. 9
CAD/CAM
4_ 2014
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I industry report _ CAD/CAM material
The screw was then secured with a highly aesthetic composite (NanoPaq
Composite, Schütz Dental) and the screw channel
was fastened.
Taking note of the patient’s existing ceramic
restorations, the patient
was advised to have a bite
tray made.
Fig. 10
Fig. 11
In order to monitor the
success of their prosthetic
treatment, the patient was
asked to attend a follow
up appointment every six
months.
_Conclusion
Fig. 12
Fig. 13
Fig. 10_Detailed view
of the crown and screw.
Fig. 11_Checking the occlusion.
Figs. 12 & 13_The final
fitted restoration.
An impression was made using an especially
customised tray and a corresponding impression
post, which fitted with the implant. The situation
was then transferred to the master model using
an individual gingival mask and a scan of the
model was made using the Tizian Smart-Scan
system for a CAD reconstruction of the crown.
The crown was constructed on Tizian Creativ RTSoftware, which lets you take the most natural
occlusal surface into account.
Following this, the crown was milled out of
Tizian Zirconia Reinforced Composite in the milling
machine (e. g. Tizian Cut 5 smart, Schütz Dental).
With the zirconia reinforced composite from
the company Schütz
Dental, the option of a
highly aesthetic material
for treating implants and
patients suffering from
parafunctions is now
available. Thanks to the material’s physical
properties, the dot-shaped chewing forces are
evenly spread across the whole restoration.
The final pictures show the harmonious integration of the restoration into the patient’s
current situation. Excellent material properties
ensure a high level of comfort for the patient,
as well as high stability and durability of the
restoration._
Editorial note: This report is not intended as a user
manual. Please consult the user manual for the systems
and materials mentioned above. All rights lie with the
treating dentist.
Next, the crown was veneered with a veneering composite (dialog Occlusal, Schütz Dental)
following the Cut Back technique.
_authors
The restoration was prepared for the screw
joint using a bonding base for full ceramic
restorations.
After the crown had been fitted, the approximal contacts checked and minimal corrections
were made to the occlusion, the crown was polished. Then the crown was definitively integrated
using a torque wrench at a speed of 35 Ncm.
14 I CAD/CAM
4_ 2014
CAD/CAM
Maximilian Kollmuß and Julia Goeke
Poliklinik für Zahnerhaltung
Dental Clinic of the University of Munich
Dental technician:
MDT Robert Kollmuß
Dentaltechnik Kollmuß GmbH, Munich, Germany
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Projekt3_Anzeigen Stand DIN A4 21.07.14 11:26 Seite 1
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[16] =>
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CAD0414_16-19_Baysal 17.11.14 12:14 Seite 1
I case report _ CAD/CAM restorations
Permanent implant
prostheses
Chairside manufacture
of a hybrid abutment crown
Authors_Drs Arzu Tuna, Umut Baysal & Rainer Valentin, Germany
Fig. 1_Tooth 26, which proved
not worth preserving, after
root resection.
Fig. 2_The state of tooth 26
after extraction.
Fig. 3_Implantation
after 12 weeks.
_In the past ten years, CAD/CAM restorations
have been established as standard in implant prostheses. The advantages of such restorations include
the chairside use of full ceramics and digital impressions. Owing to the introduction of ceramic blocks
with prefabricated twist-proof screw channels, the
workflow for the chairside manufacture of individual hybrid abutments and hybrid abutment crowns
can be applied in daily practice. By means of the
cases reported in this article, the indications, suitable
materials and attachments, and related studies are
discussed.
Fig. 2
Fig. 1
16 I CAD/CAM
4_ 2014
_Case reports
Case 1
In September 2013, a 35-year-old patient came
into our practice for the first time. The general
anamnesis found no peculiarities. She complained of
pain in the second quadrant. The clinical and the
radiological examination found that tooth 26 was
not worth preserving (Fig. 1). The patient was subsequently informed of the treatment options, which
were revision of the root canal filling, and a second
root resection and extraction with subsequent im-
Fig. 3
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case report _ CAD/CAM restorations
I
Fig. 4
Fig. 5
Fig. 6
Fig. 7
plantation. Finally, tooth 26 was extracted and implantation followed 12 weeks later (4.3 mm × 9 mm
CAMLOG implants; Figs. 2–4). We decided against
closed healing and the implant was closed with a flat
gingiva former (2 mm). With this, a further operation
to expose the implant could be avoided.
Chairside workflow
Ten weeks after implantation, the prosthetic
restoration was performed in one session without
a physical model. A digital impression was taken by
means of CEREC Bluecam (Sirona Dental Systems).
Since no exposure of the implants was necessary and
there were no open wound edges, we were able to use
the powder for the scanning procedure without any
concerns (Fig. 5). After the insertion of the CAMLOG
TiBase (Sirona Dental Systems; Fig. 6), which served
as the titanium adhesive abutment for the chairsidemanufactured hybrid abutment crown made of
lithium disilicate (IPS e.max, Ivoclar Vivadent), the
appropriate scan body (Sirona Dental Systems; Fig. 7)
was placed on the TiBase. Before taking the impression, the placement of the TiBase was radiologically
controlled (Fig. 8).
Fig. 8
The virtual construction was created by means
of CEREC Software 4.2 (Sirona Dental Systems) and
was built up similar to the crown’s construction.
An advantage of the virtual construction is the
more flexible control of the emergence profile. The
pressure on the gingiva can be adjusted individually,
and displacements of about 5 mm have proven to be
unproblematic.
Fig. 4_Four weeks after
implantation.
Fig. 5_The situation before
the digital impression.
Fig. 6_CAMLOG TiBase.
Fig. 7_Preparation for the
digital impression.
Further parameters, such as minimum strength
and position of the screw channels, should be adjusted and included in the construction according to
the manufacturer’s instructions. The manufacture of
the hybrid abutment crown was achieved with the
CEREC MC XL milling unit (Sirona Dental Systems;
Fig. 9). After the colour determination, the low
translucency A2 A16 (L) ceramic block was selected.
After glazing and colouring, the crystallisation or
combination firing was done (Programat CS, Ivoclar
Vivadent). The monolithic polished abutment crown
was then extra-orally attached (Multilink Hybrid
Abutment, Ivoclar Vivadent) to the TiBase (Fig. 10).
The hybrid abutment crown was screwed in and the
Fig. 8_Radiological control
of the TiBase.
Fig. 9_The hybrid abutment
produced by the milling unit.
Fig. 10_The hybrid abutment crown
with luting composite.
Fig. 9
Fig. 10
CAD/CAM
4_ 2014
I 17
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I case report _ CAD/CAM restorations
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15a
Fig. 15b
Fig. 11_Intraoral view after insertion.
Fig. 12_Case 2: three months
after implantation.
Figs. 13 & 14_Try-in of the hybrid
abutment crown before
crystallisation firing.
Fig. 15 a_The hybrid abutment
crown on the firing tray before
crystallisation firing.
Figs. 15b & c_Intra-oral view
of the crown.
Figs. 16–18_Case 3: implant
restoration in regio 15.
18 I CAD/CAM
4_ 2014
screw channel was sealed with PTFE tape (3M ESPE) and
composite (IPS Empress Direct, Ivoclar Vivadent; Fig. 11).
Cases 2 and 3
Figures 12 to 18 illustrate the cases of the second
and third patients. Both patients were treated following the same treatment plan described in the first case.
ceramic crown was glazed, coloured and filled with
auxiliary firing paste (IPS Object Fix Putty, Ivoclar
Vivadent; Figs. 15a–c). Case 3 shows restoration in
region 15 (Figs. 16–18).
_Discussion
Case 2 demonstrates the prosthetic restoration of
an implant in region 26 (Fig. 12). Figures 13 and 14
show the try-in of the hybrid abutment crown before
crystallisation firing. After the try-in, the polished
Restoration using CAD/CAM methods has been
established as standard in implant prostheses. Besides the industrial manufacture of materials and
the consequent high quality, the individualised,
tooth-coloured design of the emergence profile and
Fig. 15c
Fig. 16
Fig. 17
Fig. 18
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case report _ CAD/CAM restorations
flexibility regarding construction (angulation, dimension) are further advantages. Furthermore, digital
treatment concepts offer the possibility of chairside
restoration and shortened treatment duration without compromising the healing period. Systems that
do not require the use of powder offer the possibility
of detecting the implant position during implant
insertion and thus the possibility of a prosthetic
restoration during exposure. In this way, the design
and dimensions of the superstructure can be ideally
created without the need for individual gingiva
formers. From an aesthetic aspect, it makes sense to
have a natural and tooth-coloured emergence profile. In view of possible recession, the risk of exposed
metallic elements can be avoided.
_Conclusion
confirmed by recent studies. In addition, a dark discolouration of the surrounding gingiva can arise from
the worn-off titanium particles, similar to amalgam
tattoos. In aesthetically significant areas, such as
the anterior maxillary zone, this would be a serious
complication and could arise years after insertion.
Regarding the adhesive bond between the TiBase
and abutment body, the initial data is very promising.
If adhesion is performed carefully according to
manufacturer’s instructions, it should not fail.
Finally, further studies are needed to clarify the
biocompatibility of adhesive gaps with the surrounding tissue positioned 0.4 mm from the implant
shoulder and ideally also from the bone._
_contact
As described in the cases reported, the hybrid
abutment and the hybrid abutment crown together
offer a suitable alternative to full-ceramic abutments
made of zirconium dioxide ceramic. Contrary to zirconium dioxide abutments, the mating surface to the
implant body is made of titanium and not of zirconium dioxide ceramic. Since zirconium dioxide ceramic is harder than titanium, the implant body can
be affected by material abrasion, which appears to be
I
CAD/CAM
Dr Arzu Tuna
Dr Umut Baysal
Praxis am Nordwall
Nordwall 2
57439 Attendorn, Germany
www.zahnarzt-attendorn.de
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CAD0414_20-30_Vollmer 17.11.14 12:15 Seite 1
I case report _ double crowns
Double crowns made of a new
high performance polymer
Authors_Drs Rolf Vollmer, Martina Vollmer, ZTM Michael Anger & Dr Rainer Valentin, Germany
In the 70s and 80s, the bar restoration on implants
was the first choice e.g. by Ledermann (1979). Over the
years, more and more telescope or conical crown applications have been described for implant-supported
dentures. From the experience of the author it is clearly
determinable that a double crown restoration in the
mandible with four implants and secondary crowns is
indicated. For example, they would provide very good
and stable long-term results in electroplating technique
(Figs. 1a & b).
The alternatives offered in form of attachments
of various kinds stabilise the prosthesis more or less
depending on the condition of the jaw. However, these
attachments are usually inferior in fixation compared
to a double crown restoration. Especially, one-piece
implant systems—possibly with implants reduced in
diameter and length—with simple ball retaining elements, such as rubber rings, are absolutely inappropriate in terms of a later change of the superstructures.
A restoration with double crowns is more complex for
both the dentist and the technician with regards to
efforts and costs. In the following, a new technique is
described using prefabricated parts and a new material
combining the advantages of telescopic or conical
crown technology with the ease of processing and
manufacturing. The application should possibly be
done as chair side alternative, which is reasonably priced
in the dental laboratory. For fixed detachable prostheses, new possibilities for avoiding screw retention are
also described.
Fig. 1a
Fig. 1b
Fig. 2a
Fig. 2b
_Double crowns in form of telescopic or conical
crowns have been used for many decades in dental
prosthetics. In the beginning of dental implantology
prosthetics, there were still droughts about the transfer
of these constructions on the implant-supported dentures. However, in the practical application more and
more telescopic or conical prosthetics recently prevail.
_Introduction
Figs. 1a & b_Individually made
telescopic crowns with secondary
parts electroplated in “passive fit”
technology glued to a metal frame.
Figs. 2a & b_Telescopic crowns on
IMC cylinder implants
(Dr. Nikola Laux 1984).
20 I CAD/CAM
4_ 2014
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Standard_300dpi
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[22] =>
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CAD0414_20-30_Vollmer 14.11.14 13:37 Seite 2
I case report _ double crowns
_Historical development of
double crown systems
From literature it is known that Starr was probably
the first who reported, in 1886, about a removable
bridge made of double crowns. In English literature
Peeso (1924) reported about possible applications of
the double crown systems. In Germany it was Häupl in
1929 and Böttger in 1961. The breakthrough of double
crown systems took place in Germany in 1969 with
Körber (1988) who advocated the use of conical crowns
with a defined angle of convergence. Over the decades
the conical crown has become known as "German
crown" which refers to the frequent use in the Germanspeaking area until today. According to Körber (1988)
double crown systems should include, among other
things, exactly fitting pillar integration, secondary
splinting with an axial directed periodontal load and
firm support during function which is easily removable
for hygienic reasons. Furthermore, the production
should be as efficient as possible and a high economic
effect should arise by a very long survival rate, which
can be expected.
Convergence angle ␣ value at various double
crowns:
Telescopic crown: ␣ = 0 ° (clearance only)
Conical crown: 0 ° < ␣ < 8 °
Resilience telescope: ␣ may only be so large that just an
adherence occurs
Largest recommended convergence angle: ␣ < 10 °
(with double crown systems according to Muhs, 2006)
Advantages of the double crown technique
1. Straightforward extensibility after losing a primary
crown.
2. Possibility of extra-oral repairing.
3. Better and easier periodontal hygiene compared to
fixed prostheses.
4. Parallelisation of abutment teeth in the case of
divergences.
Disadvantages of the double crown technique
Körber (1988) distinguishes telescopes according to
their form:
Cylindrical telescope: It hardly tolerates technical inaccuracies and is therefore, according to Körber, classified
as problematic in manufacturing.
Cone-shaped telescope: With regard to the fit there is a
high tolerance, it allows production with a low error
rate.
Resilience telescope: Primary and secondary parts
should have some backlash in the occlusal region in order to have some space on top of each other under load.
The telescope should only undertake the functions of
friction and indirect connection of the retaining teeth
(bracing).
_Definition of the cone angle for double
crown systems
The three systems—the telescope crown, the conical
crown and the resilience telescope—are double crown
systems, which differ by the type of fit and adhesion. The
determining factor for the strength of adhesion is according to Heners (1990), the convergence angle.
In the early days of implant dentistry one was still
sceptically about the use of double crown systems on
implants. At this time, as one of the first colleagues the
dentist Dr Nikola Laux from Hamburg, Germany, introduced the use of telescopic crowns on implants (IMC
cylinder implants) in 1984 (Figs. 2a & b). In 1996, two of
the authors (Vollmer, R. and Vollmer, M.) provided a
mandibular removable prosthesis with six implants and
telescope crowns with secondary parts made of Teflon
already (Figs. 3a & b).
22 I CAD/CAM
4_ 2014
1. Complicated, precise and technical manufacturing,
high demands on the technician.
2. High costs for the work of the technician and for the
material (e.g. use of precious metal, electroplating).
3. In order to achieve aesthetic results, an intensive
substance reduction of the abutment teeth must take
place. If this is not possible, the result in the anterior
areas of the jaws is aesthetically often unsatisfactory.
4. The use of ceramic veneers fusing to the secondary
parts in the front area is risky (chipping).
5. Loss of adhesion and pull-off force after a certain time.
6. Missing or difficult possibilities of activation (post electroplating, fabrication of additional attachments).
7. When using an inexpensive base metal (non-precious
metal) / Eco-gold combination, corrosion can occur
leading to excessive friction.
_The material PEEK—A historical review
For a long time, plastics were frequently used in the
dental field. Light weight, an easy processing ability
compared to metals and ceramics, are some of the benefits. The most known plastics are Polyoxymethylene
(POM) and Polymethylmethacrylate (PMMA).
PEEK (Polyetheretherketone) is a newer polymer
which is also used for medical products since the mid90s (Fig. 5). The material was developed in 1978 and
mainly used for mechanical engineering and in the automobile industry initially. Meanwhile, PEEK is used for
the production of biomaterials in medicine, e.g. for artificial vertebral bodies, anchoring screws, artificial
[23] =>
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case report _ double crowns
Fig. 3a
Fig. 3b
joints etc. Since the original material has a dark colour,
it initially appeared to be not suitable for dental applications. However, one succeeded to vary the colour of
the material so that it could also be
used for temporary restorations and
abutments (Kirsch, 2002).
Today the following indications are
cited: full crown caps for single crown
copings, full anatomical bridges, scaffolds for veneer bridges, primary
crowns, inlays, inlay bridges and Maryland bridges. So far, the approval of the
material was limited to removable or
conditionally removable (screwed)
dentures. This means that with the described material metal-free dentures,
secondary parts, over structures with
combined dentures, implant-supported full crowns in the posterior region and conditionally removable, screw-retained
bridges can be realised.
A distinction has to be made between pure PEEK and
PEEK with additives. Recently, industrially manufactured blanks (Fig. 4) are available with an authorization
I
Fig. 4
for definitive and removable dentures (e.g. dental discs
“Tizian PEEK Blanks” Schütz Dental Ltd., Germany). The
material has no additives and is used in medicine for
many years now. Since the highly pure
PEEK material contains no additives—
such as barium sulfate—it is not visible
on X-ray control images (Fig. 6). Other
manufacturers, however, use additives
such as barium sulfate deliberately for
a radiographic display.
Figs. 3a & b_Full denture with Teflon
secondary crowns
(Vollmer, R. & Vollmer, M. 1996).
Fig. 4_PEEK prosthetic parts milled
from so-called blanks (dental discs
Tizian PEEK Blank, Schütz Dental
Ltd., Germany).
Fig. 5_Applications of PEEK in the
human body (Source: elements 39,
issue 2/2012).
Also, a so-called white-PEEK is offered in the field of dental prosthetics
from different companies. This material is mixed with up to 20 per cent titanium dioxide which makes the colour
lighter or whitish. In this method, the
hardness (flexural strength) of the material is raised, but at the same time the
Fig. 5
sliding property is deteriorated. Another disadvantage is that from the material titanium
dioxide ions go in solution and work like a ventilation element after a certain period of wear. This can lead to discolouration of the gingiva. Therefore, pure, medical
PEEK for prosthetic parts processing is rather recommended.
Figs. 6a–c_CNC machined PEEK
abutment (Dental lab/milling center
Anger, Remagen, Germany).
No radiological visibility of the PEEK
secondary part.
Fig. 7_Prefabricated primary parts of
different angulations (Schütz Dental
Company Ltd., Rosbach, Germany).
Figs. 8a–c_Clinical situation with
more severe atrophy of the mandible
in the posterior region (a);
production of total mandibular
denture before implant exposure (b);
marking the implant positions (c).
Fig. 6a
Fig. 6b
Fig. 6c
Fig. 7
Fig. 8a
Fig. 8b
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I case report _ double crowns
_The properties of PEEK
PEEK is dimensionally stable up to a temperature
of about 152 degree Celsius, the material is high melting, about 334 degree Celsius. PEEK is resistant to water and ionising radiation. Therefore, the physical
properties do not change even during sterilisation at
170 to 180 degree moist/heat sterilization at 200 degree Celsius/one bar or during sterilisation using
gamma radiation. The chemical consistency is very
good. It only reacts with concentrated sulfuric acid
(H2SO4). Therefore, the use in the oral cavity is safe and
the material has the CE mark for medical devices. The
low specific mass, the elasticity similar to the one of
bone, the absence of metals and the toughness, combined with an almost non-existent material fatigue
makes the material an ideal partner in prosthetic dentistry and implantology.
_Processing PEEK
To process PEEK the so-called "semi-finished" base
material is needed which is produced in several ways of
powders or pellets for later processing. These are:
– Extrusion
– Injection molding
– Selective laser sintering (SLS technology)
– CAD / CAM.
Figs. 9a–c_Parallelisation of the
primary parts in the mouth (a);
X-ray control (b); grinding out the
prosthesis for gluing
the secondary parts (c).
Fig. 10_PEEK secondary parts in site.
Fig. 11_PEEK abutments
polymerised in the prosthesis.
CAD / CAM technology
Since the material allows processing using CNC mills
very well, the CAD/CAM technology is used to produce
the finished parts. Elaborate individual work assignments of the dental technician in the form of scaffold
modelling with subsequent individual polymerization
can be avoided.
Tasks and objectives
The application of the double crown technique on
implants will be described in the following. The prior
mentioned advantages of the new material PEEK for
dentistry should be used for dental implant superstructures by prefabricating standardised parts. The mentioned advantages of the double crown technique
should remain and the disadvantages should be largely
avoided or allow a reconstruction in a cost effective way.
A system is described to combine the advantages of
the already known traditional custom-made double
crowns with individually milled primary parts with the
advantages of double crowns with industrial prefabrication.
Prefabricated cone parts are used with different angular deviations of the implant abutment (Fig. 7). For
these abutments perfectly fitting PEEK caps are manufactured using CAD/CAM technology.
_Different indications and
case documentations
Case 1: Removable prosthesis on two implants—direct
procedure
The cone primaries can be parallelized in the patient's mouth without time consuming impression taking and transfer to a model. Only an X-ray control
recording to verify the abutment seating is useful. The
previously made full mandibular denture (Figs. 8a–c) is
marked with silicone at the implant exit points after tissue exposure. Then, the prosthesis is milled (Figs. 9a–c)
and adjusted in the patient’s mouth to the implant
abutments covered with the PEEK caps (Fig. 10). In doing so, no later tension can arise. Using an acrylic resin,
Fig. 8c
Fig. 9a
Fig. 9b
Fig. 9c
Fig. 10
Fig. 11
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case report _ double crowns
I
Fig. 12
Fig. 13
Fig. 14
Fig. 15a
Fig. 15b
Fig. 16a
the PEEK caps are then glued in the patient's denture
directly (Fig. 11). This method enables a so-called "passive fit" of the removable prosthesis. Due to the good
adaptation of the PEEK material to the primaries a suction effect develops in addition to the friction of the
parts. The primary parts can—if necessary—be sandblasted and thus roughened to increase the friction effect. Nevertheless, this is not required in most cases if
there are sufficient parallel surfaces. In the present
case, in spite of an in the posterior area severely atrophic mandible, one has been able to achieve a very
good stabilisation of the removable prosthesis without
having the effect of a rotation around the linking axis
of the implants.
Case 2: Removable prosthesis on four implants —
half-direct procedure
The female 79-year-old edentulous patient had received a new lower denture about one year ago. She
was very unhappy all the time, until she had been informed by an acquaintance about the possibility of
dental implantation. After appropriate education and
measurement of the bone volume, four implants were
Fig. 16b
inserted in the anterior mandible (Fig. 12) to provide a
supply with prefabricated titanium primary telescopic
crowns and PEEK secondary crowns.
After three months of healing, the titanium copings
were then parallelised in the patient’s mouth (Fig.13).
The PEEK caps were adjusted to the primary crowns (Fig.
14) and both bite registration and functional impression were made in one step procedure (Fig. 15). In the
meantime, the existing prosthesis of the patient was already supplied with two PEEK caps and a soft relining,
so that the primary abutments no longer had to be removed.
In the next session, the wax try (Figs. 16a & b) and
the tertiary framework try-in was done. After the wax
try-in, the secondary PEEK crowns were placed back in
the mouth again and the premade model casting reinforcement was tried in. Since the fit was very good, according to the passive-fit method, the gluing of the
PEEK abutments with the tertiary structure in the patient's mouth was made with a dual curing material
(Fig. 17).
Fig. 12_Implants after insertion.
Fig. 13_Secondary conical parts
parallelised and fixed.
Fig. 14_Try-in of the PEEK secondary
parts.
Figs. 15a & b_Impression fixing the
PEEK parts and bite registration in
one step.
Figs. 16a & b_Wax up of the teeth
and try-in of the full denture.
Fig. 17_Tertiary framework try-in
and glueing in the patients mouth for
passive fit.
Figs. 18a–c_Repositioning of the
metal frame and check of the
passive fit.
Fig. 17
Fig. 18a
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I case report _ double crowns
Figs. 19 a & b_Prosthesis finished
and final incorporation.
Fig. 18b
Fig. 18c
Fig. 19a
Fig. 19b
After the removal of the bonded parts, the complete
part was reset to the working model (Figs. 18 a & b). There
were no deviations or tensions detected. In the dental
laboratory, the total work now could be completed so
that the integration of the prosthesis was already at the
next meeting (Figs. 19 a & b).
was used to stabilise the interim prosthesis with socalled bicortical screws.
The PEEK abutments "run" or glide on the primaries
very good. The prosthesis has a very solid tension-free
fit and can still be easily removed by the patient. Prostheses pressure points have not occurred.
Fig. 20_Situation ten years after full
implantation. Loss of one implant in
the lower right mandible.
Fig. 21_Medial shift
by the masticatory muscles.
Figs. 22a & b_Original bridge
designed for cementation. Signs of
wear, discolouration, abrasions and
cracks.
Case 3: Fixed or removable prosthesis on nine implants—
screwing or cementing or none of both?
The female patient’s age was 51 when about 14 years
ago, in the year 2000 she received maxillary and
mandibular implants. The wish of the patient at that
time was not wearing removable parts in her mouth.
Later in the maxilla, a fixed ceramic fused to metal bridge
restoration was incorporated. In the lower jaw, a 14 unit
acrylic bridge metal enforced from one piece was integrated. A retrievability was provided as in the anterior
region a larger defect was already present. This region
Fig. 21
Fig. 20
26 I CAD/CAM
4_ 2014
However, since it turned out that after the healing
the bicortical screws were absolutely stable and firmly
healed, they were left in the jaw and incorporated into
the prosthetic construction.
After about ten years, the patient started having
problems at the distal right implant which turned out
to be loose and had to be removed (Fig. 20). After a
small makeover, the existing bridge was then reintegrated.
The implant failure had likely been caused by the
so-called medial shift (Fig. 21) of the mandible and the
cantilever construction. Sometimes, this effect is also
observed in bridges in the mandible, ranging from the
anterior region to the wisdom tooth. Especially when
the patient is older and the lower jaw shows a decrease of density, it comes to this release or decementing effect. For this reason, appropriate separation points should also be included in the mandibular
Fig. 22a
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I case report _ double crowns
Fig. 23_Clinical situation after
removing the bridge.
Figs. 24a–c_New designed
secondary parts made of PEEK;
Tertiary structure.
Fig. 25_Try-in of the tertiary
structure.
Figs. 26a & b_Glueing the tertiary
structure to the PEEK secondary
crowns.
Fig. 22b
Fig. 23
bridge restorations. Cantilever constructions should
be avoided whenever possible.
After assessments and parallelism measurements of the existing models in the dental laboratory, it turned out that there was also the opportunity to design a new restoration with the help of
PEEK secondary crowns and a tertiary cast framework for acrylic pontics without removing the original abutments (Fig. 23). The patient agreed on this
proposal.
Over the years, the gingiva of the patient was for
whatever reasons much more sensitive and the patient had great fear to lose more implants in the lower
jaw. She wore the existing bridge structure only as a
kind of a loose removable bridge. Since the design was
intended for at least a temporary cementation, it always came to a wear and chipping of the plastic veneers, which could no longer be repaired (Figs. 22a & b).
Now, in 2014, the patient is 65 years old and a new
treatment-plan with three divided bridges for cementation was suggested. However, she refused and
insisted to get a part that is removable or to have the
old one repaired, which for technical reasons was not
possible. There were different solutions discussed including new primary telescope parts and electroplating technique for the secondary parts. A decision was
not made by the patient especially because of cost
reasons. The only statement was that she wanted to
have something like a removable bridge.
First, the PEEK secondary parts, some of which
were splinted, were tried in (Figs. 24a–c). The fitting
was very good. The model casting reinforcement for
the tertiary structure also fitted perfectly (Fig. 25). So
the bonding of both (PEEK and metal frame) similar to
the previous case was done directly into the patient’s
mouth (Figs. 26a & b). In this case, a pick-up impression in the double mixing method was manufactured
(Fig. 27). The bite was registered over the tertiary
structure. The result was a very good matching,
stress-free, removable bridge with a pleasant chewing comfort that meets the needs and expectations of
the patient (Figs. 28 & 29).
Fig. 24a
Fig. 24b
Fig. 24c
Fig. 25
Fig. 26a
Fig. 26b
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case report _ double crowns
Fig. 27
Fig. 28a
I
Fig. 28b
Case 4: Fixed prosthesis on two implants and three unit
bridges —screwing or cementing or none of both?
This 77-year-old patient was already supplied
with multiple implants and wanted the gap 23 to 25
to be filled with a fixed bridge (Fig. 30). Since it was a
FP 3 option or indication according to C.E. Misch and
hygiene deficits of patients had to be corrected with
the help of a professional dental cleaning, in this case
we decided to manufacture, similar to the previous
case, a removable bridge which was neither cemented
nor bolted.
neers fused to the secondary parts is possible and
chipping avoided (Fig. 33).
The process was corresponding to the case before.
The difference was that we were using porcelain fused
to metal. The bridge was glued in the mouth to the two
PEEK caps (Figs. 31, 32a & b). Now, the patient has a
very good chewing comfort. The prosthesis can be removed from the prophylaxis assistant very well. The
problem of a cemented bridge with the appropriate
cement residues, a possibly too strong adhesion and
a difficult retrieve possibility was avoided as well as
the disadvantages of screwing. The use of ceramic ve-
Case 5: Removable prosthesis on four implants and
Locator® attachments—unsatisfied patient
The patient, aged 81 years, had significant problems
with the adhesion and fit of his lower jaw full prosthesis for years. Because of cost concerns a bar or telescoping construction using electroplating was omitted. Although the initially applied two anterior implants with
a simple ball connection device ensured a stabilization
of the prosthesis, there were always returning pressure
sores and points in the posterior region of the mandible
Fig. 29b
Fig. 29a
Fig. 27_Impression to fix the
superstructure.
Figs. 28a & b_Final prosthesis.
Figs. 29a & b_Clinical situation.
Fig. 30_Clinical situation, FP 3 /4
acc. to C.E. Misch.
Fig. 31_Peek parts on the stumps.
Figs. 32a & b_Porcellain fused to
metal bridge with PEEK secondaries
before glueing together.
Fig. 33_Finalised bridgework.
Fig. 32a
Fig. 30
Fig. 31
Fig. 32b
Fig. 33
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I case report _ double crowns
Fig. 34_Combination of Locator®
abutments and prefabricated conical
crowns for better stabilisation.
Fig. 35_Remanufactured
mandibular denture.
Fig. 34
Fig. 35
causing pain. Later, two more implants were placed anterior because of the patient's request for a better stabilization of his prosthesis. However, the construction on
four implants with Locator® attachments brought only
a little improvement. Still, the patient was not 100 per
cent satisfied, even though the prosthesis was underlined and perfectly fitting the jaw. Later, to eliminate the
tilting movements in the distal jaw area during mastication, two Locators® were replaced by a prefabricated
cone crown system with PEEK secondary parts (Fig. 34).
_Conclusion
The immediate stable position and the perfect fit of
the mandibular denture were amazing. Finally, the patient got the desired result, which was within his personal budget (Fig. 35).
_Discussion
In recent years, a variety of proposals for affordable
dental implant solutions for the patient are made according to Held. If one earlier estimated that four implants are necessary for a stable construction in the
mandible, we are confronted with concepts varying
from All-on-4 ® (Paolo Malo) to "All-on-One" (“Better
one than none”) e.g. a multicentre study by the University of Kiel, Prof. Dr Matthias Kern. The aim of the study
is to provide more and more patients with a cheap and
simple reconstruction in limited indications such as a
very strong distal atrophy of the mandible. In general,
money-saving reduced implant solutions have the disadvantage that the loss of a single implant already leads
to a complete redesign and start from the beginning.
This has to be considered during the complete planning
process. A construction of two implants only with the
use of pre-fabricated parts is—at least in the lower jaw
—a good compromise between a minimal solution (one
implant) with a very restricted indication and an only
moderate stabilisation and prosthetic cost effective solutions that are based on at least four implants. The new
high-performance polymer PEEK offers in combination
with prefabricated conical crowns many ways especially with the use of CAD/CAM technology to expand
the prosthetic range on a low-cost basis. The corrosion
phenomena when using non precious metals/Eco gold
can be avoided.
30 I CAD/CAM
4_ 2014
The bar prosthetic construction in the mandible
propagated by Ledermann (1979) is currently the only
scientifically validated indication. Every other described
technique still requires further clinical testing and scientific evidence of their suitability.
The here described treatment option should combine the advantages of a high-quality implant restoration with the advantages of low-cost simple fabrication.
The use of prefabricated components and the use
of a new cost economical material enable well-fitting
stable constructions, especially in cases of advanced
mandibular atrophy. New indications like cement and
screw less fixed solutions are of special interest and very
challenging. Ceramic veneers can be fused to the secondary parts also in cases of removable bridges and
avoid chipping.
New materials in the implant prosthetics will continue to offer new additional possibilities. Here, the
imagination of colleagues for further development is almost not limited. The use of ceramic veneers fusing to
the secondary parts in the front area is risky (chipping).
There is still much to do. Let's do it!_
Editorial note: A list of references is available from the
publisher.
_contact
Dr Rolf Vollmer
Nassauer Str. 1
57537 Wissen, Germany
info.vollmer@t-online.de
Zahntechnik Michael Anger
Drususstr. 8–9
53424 Remagen, Germany
info@ma-fraeszentrum.de
CAD/CAM
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I case report _ immediate restoration
Implant-supported
immediate restoration
in the edentulous maxilla
Author_Dr Fernando Rojas-Vizcaya, Spain
Fig. 1
Fig. 2
Fig. 1_Pre-treatment
clinical situation.
Fig. 2_Panoramic radiographic
view of the remaining bone.
Fig. 3_Prosthetically driven
guided drilling.
Fig. 4_Implant placement.
Fig. 3
_Introduction
Implant dentistry has become an established
form of treatment with good and predictable
results for functional and aesthetic reconstruction
in cases of masticatory dysfunction. As bone in the
maxilla is often soft and sometimes insufficient
in volume, the edentulous maxilla could be a great
challenge for the treating dentist. The type of treatment chosen is crucial for success, in particular
when a fixed immediate restoration is requested by
patients. In such cases, successful treatment re-
Fig. 4
32 I CAD/CAM
4_ 2014
quires primary stability of the implants inserted
and a sufficient number of implants to support the
superstructure.1
In addition, exact placement is essential and
can be achieved by means of computer-assisted
planning. At least six implants are recommended
to support a fixed restoration in the edentulous
maxilla.2 Moreover, in soft bone, it is necessary to
use an implant system that guarantees sufficient
primary stability due to its external geometry and
its thread design.3
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case report _ immediate restoration
Another precondition for successful treatment is
a tension-free fit of the prosthetic superstructure.
Also desirable is primary splinting of the implants
by the superstructure, which can be achieved with
a milled bar restoration. Utilising CAD/CAM technology, highly precise wide-span solutions can be
manufactured today with an accurate fit.
_Case report
A 69-year-old female patient presented to our
practice. Apart from teeth 17 and 27, her maxilla
was edentulous. The remaining teeth could not be
permanently preserved due to the periodontal
status. A removable temporary denture was an-
I
Fig. 5
Fig. 6
Fig. 7
Fig. 8
chored to the maxillary molars. The patient requested a fixed restoration to permanently restore
masticatory function and aesthetics.
The clinical and radiographical examination
showed that sufficient bone was available to place
implants that would support a fixed restoration
(Figs. 1 & 2), and a bar-retained immediate restoration on six OsseoSpeed EV implants was planned.
The OsseoSpeed EV implants and the new drilling
protocol allow for excellent primary stability, which
makes this an ideal treatment solution for this
particular case. In addition, the OsseoSpeed surface
is especially indicated for use in soft bone applications.
Fig. 5_Installation
of the Uni Abutments EV.
Fig. 6_Uni Abutment EV Temporary
Cylinders attached to the abutments.
Fig. 7_Perforated denture to gain
free space around Uni Abutment EV
Temporary Cylinders.
Fig. 8_Abutment access
covered with silicone.
Fig. 9_Peri-apical radiograph
showing the implants at bone level.
Fig. 10_Uni Abutments EV exposed
for impression taking.
Fig. 9
Fig. 10
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I case report _ immediate restoration
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 11_Uni Abutment EV Pick-Ups
attached to the Uni Abutments.
Fig. 12_Uni Abutment EV Replicas.
Fig. 13_ATLANTIS ISUS Hybrid
virtually designed.
Fig. 14_ATLANTIS ISUS Hybrid
designed with retention elements.
Fig. 15_Final prosthesis
secured clinically.
Fig. 16_Final restoration.
Fig. 15
In order to safely and exactly place the implants,
the use of a surgical template was planned. The maxillary provisional denture was duplicated and the
laboratory created a surgical template from it. The
surgical template was used to determine the best
prosthetic position for the implants (Fig. 3). After incision and raising a flap, the bone proved to be of good
quality and of sufficient volume to ensure a buccal
bone wall of approximately 2 mm after implant
placement. In all, six OsseoSpeed EV 3.6 S implants
were placed in the maxilla. The recommended drilling
protocol was followed, using the Twist Drill EV, Step
Drill EV and Cortical Drill EV. The implants were inserted with a torque of 25 Ncm, using a contra angle
and the Implant Driver EV (Fig. 4). The final installation
Fig. 16
34 I CAD/CAM
4_ 2014
was carried out manually. Subsequently, 2 mm Uni
Abutments EV were manually connected to the implants using the Uni Driver EV (Fig. 5). Uni Abutment
EV Temporary Cylinders were placed on the abutments
to attach the temporary restoration. The surgical procedure was completed by replacing the soft tissue
flaps and suturing around the abutments (Fig. 6).
The existing provisional denture was grinded
generously at the level of the temporary cylinders so
that it could be safely placed on top of the cylinders.
The maxilla was covered with a rubber dam to
protect the newly sutured surgical wound (Fig. 7).
The reduced temporary denture was secured to the
cylinders with self-hardening plastic. Afterwards,
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case report _ immediate restoration
I
the cylinders were shortened to denture level,
and their channels were closed with silicone (Fig. 8).
The patient thus received a temporary immediate
restoration in one treatment session. Radiographs
showed an excellent fit of the abutments and cylinders and a good positioning of the implants (Fig. 9).
After osseointegration of the implants, teeth 17 and
27, which could not be preserved, were extracted.
After eight weeks of healing, the temporary denture was removed and the Uni Abutments EV were
exposed to prepare for the final impression (Fig. 10).
For this procedure, Uni Abutments EV Pick-Ups were
connected to the abutments and the impression was
made using a customised impression tray (Fig. 11).
When the impression material had set, the pins
were unscrewed and the impression was removed.
Uni Abutment EV Replicas were attached to the
Fig. 17
good oral and denture hygiene (Fig. 16). The control
radiographs showed the marginal bone to be at the
level of the implant shoulder and also an excellent
fit of the prosthetic restoration (Fig. 17). Aesthetics
and function were ideally recreated and the upper
lip was well supported by the prosthesis. The patient
was very satisfied with the result (Figs. 18a & b).
Fig. 17_Peri-apical radiograph
showing the perfect fit
of the restoration.
Fig. 18a
Fig. 18b
pick-ups in the impression to prepare the master
model made from dental plaster stone (Fig. 12).
A diagnostic wax-up was created on the model to be
able to plan the exact location and dimension of the
planned bar structure. The model and wax-up were
sent to DENTSPLY Implants manufacturing center,
where they were scanned, and the data was transferred to the ATLANTIS ISUS software. Using the software, an ATLANTIS ISUS Hybrid superstructure was
designed (Fig. 13). After review and approval of this
design by the dentist and dental technician, the framework was milled from a solid block of cobalt-chrome
in the DENTSPLY Implants manufacturing centre.
_Conclusion
Review of the precise fit was controlled and verified in production as well as referring to the master
model (Fig. 14). With the previously created wax-up,
the final restoration was completed. The ATLANTIS
ISUS Hybrid superstructure was installed to the
abutments with a torque of 15 Ncm (Fig. 15). The
screw channels were subsequently sealed with
composite. The contact area of the denture with the
maxillary mucosa was designed in a slightly convex
form that prevents air from escaping, avoids phonetic problems and food impaction, and allows for
_about the author
Figs. 18a & b_Final
aesthetic outcome.
Restoration of the edentulous maxilla with an
implant-supported fixed restoration presents great
challenges for the treating dentists. The present case
describes how an excellent prosthetic restoration can
be created both in terms of function and aesthetics
using the ASTRA TECH Implant System EV and an
ATLANTIS ISUS patient-specific implant superstructure._
Editorial note: A complete list of references is available
from the publisher.
CAD/CAM
Dr Fernando Rojas-Vizcaya,
DDS, MS
Department of Prosthodontics
University of North Carolina,
Chapel Hill, NC, USA
Director of the Mediterranean
Prosthodontic Institute,
Castellon, Spain
CAD/CAM
4_ 2014
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I industry report _ bonebuilder technology
Paving the way for
a patient-friendly, minimally
invasive approach in
alveolar ridge augmentation
Author_Dr Yasmin Buchaeckert, Germany
Figs. 1 & 2_maxgraft bonebuilder
—from the CAD/CAM-based
3-D design to the customised
allogenic bone implant.
Figs. 3–6_Conversion of
a CT/CBCT scan into a 3-D model.
Digitally planned implants can
be transferred into the planning
software and the customised bone
block can be designed according
Fig. 1
Fig. 2
_Dental implantology is currently one
of the most important treatment strategies
for the replacement of missing teeth. The aim
is to achieve a functionally stable, long-lasting implant, with an aesthetic outcome. Due
to the reduced mechanical challenge, tooth
loss induces progressive bone tissue atrophy.
Thus, it is often necessary to reconstruct alveolar ridges before implants can be inserted.
_Autografts
Fig. 3
Fig. 4
Fig. 5
Fig. 6
36 I CAD/CAM
4_ 2014
For three-dimensional (3-D) augmentations in cases of extensively atrophic ridges,
onlay block grafting is the method of choice.
Autologous bone is still considered the gold
standard in block grafting. However, the intraoral availability of autologous bone for
transplantation is limited. Therefore, bone
harvesting from the iliac crest is required in
cases of large defects.
Tissue harvesting, however, involves a
second surgical site that is frequently associated with potential donor site morbidity
and increased risk of pain. Furthermore, the
harvesting of bone from the iliac crest is often
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industry report _ bonebuilder technology
I
associated with pronounced and long-term
neurological symptoms.
_Allografts
Alternatively, allogenic bone (from human
donor tissue, known as an allograft) may be
applied to avoid the additional risks that come
with harvesting autologous bone. Due to its
physiological structure, allogenic bone provides an ideal matrix for revascularisation and
new bone formation. Since it is fully resorbable,
it supports natural bone remodelling. Moreover,
allografts are biocompatible and, like autografts, do not induce immunological reactions.1
Fig. 7
Fig. 8
Fig. 9
Fig. 10
_Classical onlay block grafting
to the alveolar ridge required in order
to achieve stable implant positioning
(patient data provided by Dr Markus
Schlee, Forchheim, Germany).
Figs. 7–10_Complex reconstruction
of the maxillary ridge by digital
backward planning—
from superconstruction
to customised bone blocks
(patient data provided by
Masoud Memari, Budapest, Hungary).
Figs. 11 & 12_Digital simulation of
the milling process after import of the
*.stl .le in the CNC-milling machine.
Histological studies of the final stages of
graft incorporation identified no difference
between allografts and autografts.2, 3 The
allogenic bone tissue originates from living
donors who are undergoing total hip replacement surgery and are willing to donate their
femoral heads to support the supply of bone
graft material for medical use. Donors have to
meet high standard criteria in terms of their
health status in order to be selected; systemic
and neurological diseases, acute or chronic
infections, and existing or past malignancies
are only a few of the exclusion criteria.
Every single donor undergoes serological testing
to detect the presence of virus antigens by nucleic
acid testing (NAT). The donated tissue is processed
in a multi-level cleaning process, which removes
organic components and non-collagenous proteins
from the mineral phase of the bone. This process
is also validated for its effectiveness to reliably inactivate potentially present viruses and bacteria.
The unique processing of the donor tissue preserves
the natural collagen content of the allograft bone,
rendering the material with increased flexibility,
simple handling, and with more potential applications,
compared to synthetic or bovine bone substitutes.
The most important application for allografts is
onlay block grafting; in the 3-D reconstruction of large
defects, the block allograft ensures the necessary volume stability during graft incorporation. However, it is
crucial during this initial phase of vascularisation and
graft incorporation to establish the largest possible
contact area between the block and the local bone bed.
During conventional block grafting, a standardised square block has to be manually modified for
adaptation to the surface of the local bone during
the surgical procedure.
Fig. 11
Fig. 12
CAD/CAM
4_ 2014
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I industry report _ bonebuilder technology
Fig. 13
Fig. 14
Figs. 13–15_Handling of maxgraft
bonebuilder in surgery. Fixation
by osteosynthesis screws,
filling of residual gaps with
bone regeneration material
(here: botiss cerabone), covering
of the augmentation site
with a collagen membrane
(here: botiss collprotect membrane),
and tension-free wound closure.
It is a technique-sensitive and
time-consuming process. Moreover, the prolonged exposure of
the surgical site to saliva and air
increases the risk of infection and
delayed wound healing.
_Customised allogenic
bone transplants
for onlay block grafting
botiss offers a new technology Fig. 15
that provides the clinical user with a
pre-fabricated, customised allogenic bone block, which
is individually designed to match the patient’s defect.
The individual maxgraft bonebuilder block
(Figs. 1 & 2) is designed using 3-D digital radiographs
(CBCT) of the defect and CAD/CAM technology.
Fig. 16
38 I CAD/CAM
4_ 2014
The radiological data is transferred into CAD/CAM
planning software that builds a 3-D digital model
of the scans (Figs. 3–6, patient data provided by
Dr Markus Schlee, Forchheim, Germany). Based on
this virtual model, the botiss specialists design the
allograft block directly on the virtual defect with
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I
Fig. 17
the use of a digital backward planning concept
(Figs. 7–10, patient data provided by Masoud Memari,
Budapest, Hungary). Starting with the design of
a possible superconstruction, the approximate
implant position may be mimicked and virtual implants inserted. If the implants are digitally planned
by the clinical user, these data can be transferred and
the exact implant positions can be displayed in the
3-D model. The block graft is subsequently designed
to fit around the virtual implants, according to the
final bone bed needed for stable implant insertion.
_Individually designed in close
cooperation between clinical user,
CAD specialist, and tissue bank
The complete planning process is a product of
direct interaction between the clinical user, the
CAD specialist, and the producing tissue bank. Bone
blocks are individually designed to meet the requirements for sufficient augmentation of the alveolar
ridge in careful consideration of the soft tissue situation of the patient, which can only be assessed by
the attending surgeon himself. The final 3-D version
of the bone block is converted into a *.stl file and
transferred to the botiss partner tissue bank C+TBA
(Cells and Tissuebank Austria, Krems). The block is
produced under cleanroom conditions in accordance with pharmaceutical standards. The *.stl file is
imported into a CNC-milling machine in which, after
a simulated test run (Figs. 11 & 12), the final graft is
produced from a partially processed allogenic block.
After packaging and final sterilisation, the maxgraft
bonebuilder block is sent directly to the clinical user.
In surgery, after it is brought into position, the
maxgraft bonebuilder block is fixed with regular
osteosynthesis screws. Residual gaps can be filled
with bone regeneration material and the augmentation site is covered with a collagen membrane before
the wound is closed tension-free (Figs. 13–15).
_Reduced surgery time,
quick and uneventful wound healing
The pronounced fitting accuracy of the bone
builder block facilitates optimal revascularisation
and graft incorporation. The operation time during
block grafting is significantly reduced, thereby promoting quick and uneventful wound healing. It also
allows the surgeon to focus on the management of
the soft tissue, which is the actual key for success.4-6
Due to the significant reduction in operating
time, costs and, most importantly, patient morbidity, the unique maxgraft bonebuilder technology
paves the way for a patient-friendly, minimally invasive approach in alveolar ridge augmentation._
Editorial note: a complete list of references is available
from the publisher.
_about the author
CAD/CAM
Dr Yasmin Buchaeckert, Senior Product
Manager Allografts at botiss biomaterials.
yasmin.buchaeckert@botiss.com
CAD/CAM
4_ 2014
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I industry news _ Planmeca
Planmeca ProMax CBCT
with CAD/CAM technology:
the perfect combination
Now, consider combining this detailed information below the gum line with images from an
intraoral scan, capable of capturing the highest
resolution of data above the gum line. This combination of CBCT and STL data from CAD/CAM sources
gives doctors the ability to provide the required
information and tissue leveling for a crown down to
an implant plan.
Fig. 1
Fig. 1_The Planmeca PlanMill
in-office milling unit.
Fig. 2_Planmeca’s PlanCAD
software at work.
40 I CAD/CAM
4_ 2014
_CBCT imaging is becoming the new standard
of care for complete patient information. These
images provide multi-faceted views of teeth and
everything below the gum line, including the
mandibular nerve canal, making them an invaluable
tool for planning implant cases and other restorative treatments.
Fig. 2
In most cases, the STL data can also be utilized
by the lab to create the final surgical guide for
placing the implant with unparalleled accuracy and
speed. Temporary and final restorative crowns can
be milled in-office in a matter of minutes or milled by
a lab in as little as 24 hours. Planmeca’s imaging and
CAD/CAM technology have captured this concept
with the ProMax 3-D family of imaging units and the
PlanScan/PlanMill systems, offering doctors the ability to acquire a data set with more detail than ever.
_Streamlining the digital workflow
Digital dentistry is streamlining virtually every
aspect of the restorative workflow. Traditionally,
doctors submit a physical impression to the lab with
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industry news _ Planmeca
the prescription and instructions written out on
paper. This is gradually ceding ground to an entirely
digital process where the patient’s information and
doctor’s instructions are sent to the lab electronically via a digital impression system.
I
Fig. 3_The ProOne features
an easy-to-use color graphic
user interface (GUI) with touch
magnification for image verification.
Planmeca PlanScan Restorations can be delivered
mere days after the laboratory receives the patient’s
intraoral scans, while the Planmeca PlanMill 40
in-office milling unit is making same-day dentistry
a reality. The restorations produced by the PlanScan
restorative system, along with the combining of
the digital impression with CBCT scans, reduce the
costs and treatment time associated with replacing
a tooth, increasing the demand for digital dentistry
exponentially.
For those who want to continue to work with their
labs, all of the patient information needed to produce
a model-less restoration can be submitted digitally
to a dental laboratory. At the same time, clinicians
enter the patient’s information and prescription data
into their digital impression system’s software prior
to submitting each case. Because the Planmeca PlanScan system is an open system and the dental team
can send the file in a standard DICOM format, exchanging patient data is easy between most systems
through Planmeca Romexis software.
_Bringing today's dental practice up to
speed with Planmeca Romexis software
and cloud service
While digital impression systems are realizing
a data standardization solution, the digital X-ray,
practice management, cone-beam computed tomography (CBCT) and digital treatment-planning
systems found in today’s dental practice require the
same sort of attention. Because these systems lack
interoperability, they are unable to efficiently communicate patient data and reach their true potential.
To truly maximize the efficiencies and cost savings
offered by these technologies, interoperability is imperative among these dental systems that are becoming increasingly common in today’s dental practice.
As clinicians demand data standardization, the transfer of the patient’s information, X-rays, CBCT scans,
digital impressions and prescription data between the
dental office and the dental lab with the simple push
of a button is now possible with Planmeca Romexis
software and Planmeca Romexis Cloud.
_Maximizing practice profitability
with open architecture
Data standardization is essential to driving down
costs for patients, doctors and laboratories alike
Fig. 3
by establishing interoperability between intraoral
scanners, CAD/CAM software and other dental
systems. Ultimately, having a common standard
that allows the disparate systems used in dental
care to function as plug-and-play devices rather
than requiring pricy IT solutions will reduce the
costs of integrating these new technologies into
dental practices and maximize the ROI of the
equipment.
Planmeca’s CBCT and CAD/CAM imaging systems, along with Planmeca Romexis digital treatment planning software, are using this idea to
improve the efficiency, predictability and costeffectiveness of dental restorations, making chairside dentistry a lucrative investment for dentists
who wish to grow their practice and offer patients
the latest in same-day technology._
_contact
CAD/CAM
Planmeca Oy
Asentajankatu 6
00880 Helsinki
Finland
www.planmeca.com
CAD/CAM
4_ 2014
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I industry news _ DENTSPLY Implants
DENTSPLY Implants
expands into new markets
New solution from DENTSPLY Implants: Simplicity without
compromise with the new ASTRA TECH Implant System EV
Fig. 1
Fig. 1_ASTRA TECH Implant System
BioManagement Complex.
_DENTSPLY Implants’ next step in the continuous EVolution of the ASTRA TECH Implant System
continues. The ASTRA TECH Implant System EV is
designed with a site-specific, crown-down approach based on the natural dentition for increased
surgical simplicity and flexibility and restorative ease
—without compromising the unique ASTRA TECH
Implant System BioManagement Complex.
The main objective of the new system is to further improve system logic, robustness and user
friendliness. Simplicity without compromise has
permeated the evolution of the ASTRA TECH Implant
System EV and the new system is a result of the
collaborative input and insights from dental professionals throughout the global dental industry.
_SIMPLANT with ASTRA TECH Implant
The foundation of this evolutionary step is the
System EV
unique ASTRA TECH Implant System BioManagement
Complex, well documented for its long-term marginal bone maintenance and aesthetic results
provided by the combination of the key features:
the OsseoSpeed surface, MicroThread, Conical Seal
Design and Connective Contour.
42 I CAD/CAM
4_ 2014
At the European Association of Osseointegration
(EAO) Annual Meeting in Rome, Italy, September 25–27,
DENTSPLY Implants presented SIMPLANT computer
guided implant treatment with ASTRA TECH Implant
System EV.
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industry news _ DENTSPLY Implants
I
Fig. 2_SIMPLANT computer
guided implant treatment with
ASTRA TECH Implant System EV.
Fig. 2
AD
SIMPLANT is a comprehensive system based on
3-D imaging, allowing for precise implant planning
and predictable restorative results. Using SIMPLANT
with ASTRA TECH Implant System EV unlocks the
potential of digital driven crown-down planning
and enhances the treatment outcomes for the
benefit of the patients. Furthermore, working
with a complete digital workflow allows for even
greater simplicity and efficiency in the treatment
process.
ASTRA TECH Implant System EV highlights:
_Versatile implant assortment;
_Flexible drilling protocol that allows for preferred
primary stability;
_User-friendly surgical tray with three interchangeable overlay options;
_Colour-coded assortment;
_Unique interface with one-position-only placement of ATLANTIS patient-specific abutments;
_Self-guiding impression components;
_One system—one torque.
For more information and highlights of the
new ASTRA TECH Implant System EV, please visit
the campaign site: www.jointheev.com_
• Non-precious dental alloys on nickel-chrome
base System KN and System NH
• Non-precious dental alloys on cobalt-chrome
base System NE and System Duro
• Partial alloy System MG
• CAD/CAM discs on cobalt-chrome
base System NE-Blank and System Soft-Blank
• CAD/CAM disc on titanium base System Ti5-Blank
_contact
DENTSPLY Implants
www.dentsplyimplants.com
CAD/CAM
Ringstr. 38 - 44 50996 Koeln-GERMANY
Phone + 49 2 21 - 35 96 - 100 Fax + 49 2 21 - 35 96 - 170 info@adentatec.com
www.adentatec.com
CAD/CAM
4_ 2014
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I industry news _ 3Shape
3Shape TRIOS recognised
with “Best of Class”
Technology Award
software updates and serve to futureproof the digital impression solution.
“We are seeing a tremendous buzz
surrounding TRIOS in the market right
now. And we are grateful to Pride Institute
and our fellow industry professionals for
helping to create the strong interest and
for rewarding our efforts in improving
patient care and dental technology with
the award,” stated Flemming Thorup,
President and CEO of 3Shape.
Dr Lou Shuman, President of Pride
Institute and creator of the award and
its selection process, said about TRIOS:
“In this highly competitive category,
3Shape’s TRIOS has once again impressed
the panel on many fronts. We are very
excited to see 3Shape choosing not to
rest TRIOS on its laurels. Since winning
last year, they have added many features,
like shade measurement and HD image
taking. Combining these with TRIOS’ fast
and easy scanning and its intuitive interface makes the solution the clear leader
and most innovative in the intraoral
scanner product category.”
Since its launch in 2011, 3Shape
TRIOS, an intraoral scanner and
digital impression solution for
dentists and orthodontists,
has received numerous awards.
(Image: 3Shape)
44 I CAD/CAM
4_ 2014
_3Shape’s TRIOS digital dental impression solution has been given the “Best of Class” Technology
Award for the second year in a row. Pride Institute
presents this honour annually to global products
that deliver best-of-class value to dentists and the
dental industry.
The American Dental Association and Pride
Institute presented the awards at their joint Technology Expo at the association’s annual meeting,
which was held at the beginning of October in
San Antonio in the US._
3Shape has worked closely with dentists and
orthodontists to develop the digital impression solution since its launch three years ago. Practitioners’
feedback has been instrumental in driving the creation of breakthrough technologies in TRIOS, such
as shade measurement, high-definition images and
colour scanning, as well as improving scanning speed
by 40 per cent over the past year. These features
are shared with users of the device via unlimited
_contact
3Shape A/S
Holmens Kanal 7
1060 Copenhagen K
Denmark
www.3shapedental.com
CAD/CAM
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industry news _ Adentatec
I
Adentatec
Competence in Dental
_Adentatec, based in Cologne in Germany, is a
global dental company specialising in the production and distribution of non-precious dental alloys on a cobalt–chromium and a nickel–chromium
base, as well as CAD/CAM discs on a cobaltchromium and a titanium base. The medical devices distributed by Adentatec are exclusively produced in Germany and are certified to the highest
standards (CE marking and US Food and Drug Administration). Adentatec is committed to the strict
implementation of the quality and process requirements of DIN EN ISO 13485 and DIN EN ISO 9001 in
relation to the entire manufacturing process.
The company was established in 1997 and its focus at that time was the distribution of sand-blasting material and plaster to dental laboratories all
over Germany. In 2003, Adentatec started production of high-quality dental alloys, for which it implemented a quality management system. Its products undergo biocompatibility and corrosion resistance tests, among others, and are manufactured
from high-quality raw materials to ensure consistent quality. Adentatec has always given priority to
patient health. Since 2005, the company’s export
business has increased steadily. Adentatec now has
more than 20 agents worldwide who represent its
product range.
The company’s brand-name products, such as
System KN, System MG and System NE, have long
been widely used by dental technicians. Its product
range includes plaster, investment material and
sand-blasting material. In 2009, Adentatec expanded the range to CAD/CAM discs on a cobalt–
chromium base (System NE-Blank and System SoftBlank). The high-quality discs are available in different diameters and heights, and can be used for all
open milling systems. The discs are soft, homogeneous and easily milled. The strong oxide provides
excellent metal to ceramic bonding. Importantly,
the discs have high corrosion resistance and biocompatibility. In 2012, the company’s CAD/CAM disc
on a titanium base, System Ti 5-Blank (Grade IV), was
launched.
The Adentatec team is always motivated to support their customers as best as they can. The company is represented at many dental exhibitions all
over the world to keep in touch with customers and
to introduce its products to prospective customers
face to face. Adentatec seeks to establish a mutual
relationship with its suppliers, customers and business partners._
_contact CAD/CAM
Adentatec GmbH
Konrad-Adenauer-Str. 13
50996 Cologne
Germany
info@adentatec.com
www.adentatec.com
CAD/CAM
4_ 2014
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I industry news _ Nobel Biocare
One streamlined flow
_Integrated and efficient treatment workflow
gives clinicians and labs the option to connect.
Linking each step into an integrated workflow
can offer predictable results in less time.
Providing the best in dental treatment care is
rarely a one-person show. Collaboration is often
From clinical diagnostics to implant placement, each step is seamlessly linked by the
essential—and shared responsibilities can actually
increase efficiency.
NobelConnect network, giving you the option
to select only what you need for treatment success. Guided surgery is an option at any point
during planning with no need for another patient
visit.
Nobel Biocare’s integrated and efficient treatment workflow connects the NobelClinician Software with the NobelProcera 2G System, NobelGuide
and OsseoCare Pro, offering a straightforward
process from diagnosis to restoration. The workflow
even brings in dental labs using NobelProcera at
the planning stage with new scanning capabilities
that provide a full diagnostic view.
46 I CAD/CAM
4_ 2014
_Communicate convincingly
The visual nature of the digitised treatment plan
using NobelClinician is very useful when explaining
treatment proposals to patients.
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industry news _ Nobel Biocare
With the NobelClinician Communicator iPad
app, the treatment can be presented at the planning
stage in a way that is quickly understood by patients
and treatment partners alike.
_Predictable outcomes
Editorial note: This article is a reprint from Nobel Biocare
News Vol. 15, No.1, 2014 Nobel Biocare Services AG, 2014.
All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or
is evident from the context in a certain case, trademarks of
Nobel Biocare. Product images are not necessarily to scale.
The workflow’s integrated approach makes it possible to achieve the functional and aesthetic outcome
you planned, while avoiding potential surprises. You can
also better estimate the full treatment cost in advance.
Disclaimer: Some products may not be regulatory cleared/
released for sale in all markets. Please contact the local
Nobel Biocare sales office for current product assortment
and availability.
Imagine being able to access your data or easily
and securely share your treatment plan with colleagues and partners anywhere.
_contact
With NobelConnect, your planning information
is securely stored and available in the office, at home
or while traveling.
Nobel Biocare
Balsberg
Balz-Zimmermann-Str. 7
8302 Kloten
Switzerland
With less work and more predictable treatment,
the new integrated workflow offers efficiencies
that will help you grow._
www.nobelbiocare.com/workflow
I
CAD/CAM
CAD/CAM
4_ 2014
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I meetings _ events
International Events
2014
2015
ADF Meeting
25–29 November 2014
Paris, France
www.adf.asso.fr
ICOI 2015 Winter Implant Symposium
22–24 January 2015
Orlando, USA
www.icoi.org
Great New York Dental Meeting
28 November–3 December 2014
New York, USA
www.gnydm.com
150th Midwinter Meeting
26–28 February 2015
Chicago, USA
www.cds.org
AAOMS Dental Implant Conference
4–6 December 2014
Chicago, USA
www.aaoms.org
Annual Meeting of the American
Prosthodontic Society
26–27 February 2015
Chicago, USA
www.prostho.org
36th International Dental Show
10–14 March 2015
Cologne, Germany
www.ids-cologne.de
Academy of Osseointegration
30th Annual Meeting
14–12 March 2015
San Francisco, USA
www.osseo.org
IMAGINA DENTAL
4th 3D & CAD/CAM Digital Dentistry Congress
1–3 April 2015
Monaco
www.imaginadental.org
BIOHORIZONS Global Symposium
16–18 April 2015
Los Angeles, USA
www.biohorizons.com/globalsymposium2015.aspx
EuroPerio 8
3–6 June 2015
London, UK
www.efp.org/europerio/
Paris. Photo: Jose Ignacio Soto
48 I CAD/CAM
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about the publisher _ submission guidelines
submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
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_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
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In addition, please note:
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Article lengths can vary greatly—from 1,500 to 5,500 words—
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In short, we do not want to limit you in terms of article length,
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Should you require a special layout, please let the word processing
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Please consider this when formatting your document.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com
CAD/CAM
4_ 2014
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I about the publisher _ imprint
CAD/CAM
digital dentistry
international magazine of
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
International Media Sales
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Melissa Brown (International)
m.brown@dental-tribune.com
Designer
Franziska Dachsel
Copy Editors
Sabrina Raaff
Hans Motschmann
Matthias Diessner (Key Accounts)
m.diessner@dental-tribune.com
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p.witteczek@dental-tribune.com
Weridiana Mageswki (Latin America)
w.mageswki@dental-tribune.com
Hélène Carpentier (Europe)
h.carpentier@dental-tribune.com
International Administration
Barbora Solarova (Eastern Europe)
b.solarova@dental-tribune.com
Chief Financial Officer
Dan Wunderlich
International Offices
Business Development Manager
Claudia Salwiczek
Event Manager
Lars Hoffmann
Event Services
Esther Wodarski
Marketing Services
Nadine Dehmel
Sales Services
Nicole Andrä
Executive Producer
Gernot Meyer
Editorial Board
Prof. Albert Mehl, Switzerland
Prof. Gerwin Arnetzl, Austria
Dr Stefan Holst, Germany
Hans Geiselhöringer, Germany
Dr Ansgar Cheng, Singapore
Dental Tribune International
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Copyright Regulations
_CAD/CAM international magazine of digital dentistryis published by Dental Tribune International (DTI) and appears in 2014 with four issues. The magazine
and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and liable
to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author,
represent the opinion of the afore-mentioned, and do not have to comply with the views of DTI. Responsibility for such articles shall be borne by the author.
Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility shall be assumed
for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty
representation are excluded. General terms and conditions apply. Legal venue is Leipzig, Germany.
50 I CAD/CAM
4_ 2014
[51] =>
Standard_300dpi
2G_scanner top25 CADCAM No 4.indd 1
GMT 32593 GB 1307 © Nobel Biocare Services AG, 2014. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare.
Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.
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[52] =>
Standard_300dpi
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/ Designing real smiles with digital tools
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/ Permanent implant prostheses
/ Double crownsmade of a new high performance polymer
/ Implant-supported immediate restoration in the edentulous maxilla
/ Paving the way for a patient-friendly - minimally invasive approach in alveolar ridge augmentation
/ Planmeca ProMaxCBCT with CAD/CAM technology: the perfect combination
/ DENTSPLY Implants expands into new markets
/ 3Shape TRIOS recognised with “Best of Class” Technology Award
/ Adentatec Competence in Dental
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/ International Events
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