Straumann’s newly formed relationship with Createch has enabled its clinicians to utilise the whole digital CADCAM pathway.

Case Study
Mr. SD attended with a previous history of some loosening teeth in the upper left quadrant. He had had a previous history of root canal treatments and recurrent infections that had required repeated courses of antibiotics. We discussed all the various options and suggested the best long term solution would be to extract the Upper Left 567 and provide 3 implant fixtures at UL457 with a simultaneous sinus floor elevation procedure and a restore with a 4 tooth screw retained bridge CAD CAM designed.

He was otherwise medically fit and well.

Fig 5 – 6 demonstrates the preop teeth 

Fig 5 UL567 preop
Fig 5
Fig 6 preop UL567
Fig 6

Fig 7 – preop radiograph

Fig 7 - Mr SD preop dpt
Fig 7

 

We extracted the teeth UL567 and allowed the soft and hard tissues to heal for 10 weeks prior to implant surgery.

Fig 8 Soft tissue healed

Fig 8 10 weeks healing preop stage 1
Fig 8

 

 

CBCT evaluation revealed the need for simultaneous sinus floor elevation procedure.

Fig 9 – cbct image 

Fig 9 - Mr SD cbct slice pre surg
Fig 9

Fig 10 – preop pa

Fig 10 - Mr SD preop pa
Fig 10

 

 

4.1mm tissue levels implants were placed at Upper Left 45 and 4.8mm tissue level at Upper Left 7 with excellent fixture stability.

Fig 11 – 14 shows pictures of surgery and radiographic review

Fig 11 - fixtures placed
Fig 11
Fig 12 - stage 1
Fig 12
Fig 13 closure
Fig 13
Fig 14 - Mr S D fixtures rev pa
Fig 14

 

Following 16 weeks of uncomplicated healing the implant fixtures were exposedFig 15 and scan bodies connected to record the intraoral position of the fixture heads – Fig 16 and intraoral scan picture Fig 17

 

Fig 15 implant exposure
Fig15
Fig 16 scan bodies connected
Fig 16
Fig 17 intraoral scan image
Fig 17

 

 

 

 

 

 

 

 

 

Fig 18-19 show images laboratory side of CAD design pre production of the implant framework. The design is checked and approved, then requested to be milled and returned to the laboratory within 7 days.

Fig 18 lab CAD design
Fig 18
Fig 19 abutment and framework design - pre milling
Fig 19

 

The final prosthesis can then be CAM milled and porcelain added. Fig 20 – 21

Fig 20 - prosthesis manufacture
Fig 20

 

Healing abutments are removed and any hyperplastic gingival removed – Fig 22-23

Fig 22 healing abutments removed
Fig 22
Fig 23 - hyperplastic gingival tissue removed
Fig 23

 

The final screw retained prosthesis is tried in situ, and the distal most abutments finger tightened first and we carefully and gradually tighten the abutments in situ little by little to each abutment. As usual contact points are checked that they remain passive and do not prevent full seating of the final prosthesis. Fig 24-26

Fig 24 - prosthesis in situ
Fig 24
Fig 25 - prosthesis in situ
Fig 25
Fig 26 - prosthesis in situ
Fig 26

 

 

 

 

 

 

 

 

 

A check radiograph is then taken to ensure the framework is fully seating. Fig 27

 

Fig 27 - Mr SD fit pa
Fig 27

 

And the final restoration is sealed up.

 

Fig 28 - abutmens torqued in situ and access holes retro filled with ptfe tape and composite flow
Fig 28

 

Conclusion

The release of the implant connection design to Createch now allows us to provide a guaranteed implant abutment interface with a third party company. This in turn allows us to engage the fantastic Straumann internal taper connection and match the same alloy material for the framework.

For more details on how your laboratory can benefit from the services that Createch have to offer, please contact Straumann on 01293 651230.www.straumann.co.uk

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