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12 logo 37 • CAMLOG Partner Magazine • December 2015 Fig. 20: For the final impression taking, the im- pression posts were splinted with pattern resin. Fig. 21: The image shows the optimal prosthetic positioning of the implants and the abutment design below the bridge restoration. Fig. 22: The epigingival position of the palatal abutment shoulder is checked. In the esthetic zone the shoulder is about 1.5 mm subgingival. Fig. 26: The model with the attached titanium abutments was scanned and the data fed into the CAD software. Fig. 28: After sintering the zirconia bridge with the labial reduction for the individual veneering, the bridge was tried in the mouth. Fig. 27: The zirconia bridges and the IPS e.max ® CAD crowns were adapted to the abutment transitions and the gingival situation and positioned in the blanks for milling. we screwed the green bridge off, insert- ed the tooth-colored plastic bridge again, and restored the lateral area temporarily with prefabricated temporary veneers. To implement the CAD/CAM restoration, the dental technician used the construction data acquired for the temporary restora- tion as the basis for designing the individu- al titanium abutments (Fig. 21) . He con- structed this beneath the virtual bridge. He placed the abutment-crown transition with a pronounced milled chamfer in the visible area about 1.5 mm below the gin- gival margin. This ensures harmonious es- thetics and enables access to remove any excess cement. The construction data for the eight titanium abutments were up- loaded to the Dental Manager and they were ordered from the DEDICAM fabrica- tion service (Fig. 22 to 24) . The polished DEDICAM abutments were delivered after two days. The dental technician screwed them onto the model implants, checked the design using a silicone index, and checked the location of the abutment shoulders (Fig. 25) . He then scanned the model again, and matched the data with the data saved in the software (Fig. 26 to 28) . He constructed the three-part restora- tion on the abutments, reworking the ves- tibular part of the zirconia bridge, which was to be individually veneered, for the ceramic veneers. These parts were marked for the reduction and virtually reduced by 0.6 millimeters. To avoid chipping of the labial surfaces, the incisal edges must re- main in zirconia. The zirconia bridges from 14 to 22, 34 to 37, and 44 to 47 were positioned in the blank and milled. The software enables free positioning of the bridges in the zirconium oxide blank and the generation of an optimally designed sintering stabilizer that ensures that no warping occurs during sintering. The splint- ed implant crowns 23, 24, 26, and 15, 16, and the individual crown on 27 were fab- ricated as monoliths in IPS e.max ® CAD. The crowns and bridges were sintered and the fit was checked on the model. At this stage of the fabrication, we made a raw fir- ing try-in to check the fit, occlusal planes, tooth length, and function. The pontics were clearly contoured through the plastic bridge (Fig. 29) . After checking the occlusi- on, the finishing was carried out in the lab- oratory. The vestibular parts of the upper jaw anterior bridge and the premolars in the lower jaw were individually veneered by the dental technician with appropriate ceramic compounds. The color of the mon- olithic crowns was adjusted with the help of stain firing and the crowns were then glazed and polished (Fig. 30 and 31) . After the finishing, the restorations for the upper and lower jaws were inserted in the clinic. The screw-retained plastic bridge was removed and the implant connection was cleaned with 2% chlorhexidine solu- tion. The DEDICAM titanium abutments must be promptly inserted so that the con- toured soft tissue does not collapse (Fig. 32) . The bridges and the splinted crowns were then attached for a final check of the esthetics (Fig. 33 and 34) . Because the requests of the patient and the functional requirements had been incorporated into the screw-retained temporary restoration and “frozen” in the scan, we prioritized checking the red and white esthetics. This was encouraged by the immobile attached keratinized gingiva, which we had a- chieved by thickening with roll flaps at 22 and apically repositioned flaps during the exposure (Fig. 35 and 36) . CASE STUDY