Partner Magazine logo 16

logo 16 • the CAMLOG Partner Magazine • June 2017 logo 16 • the CAMLOG Partner Magazine • June 2017 16 17 CASE STUDY Insertion of the iSy implant No pre-treatment other than professional tooth cleaning was required. Preparation of the implant bed followed after crestal, slightly palatal oriented incision, and preparation of the mucosal flap. The implant position was first marked with a round bur using an orientation template prepared in the laboratory beforehand. In-depth preparation followed with the pilot drill. The iSy direction and depth indicator was used to check the axial alignment (Fig. 6) . Then the final implant bed was prepared with the single patient form drill included in the iSy implant set. The implant, which was pre-mounted on the iSy implant base (Ø 3.8 mm/L 11 mm), was inserted. Due to the platform switch, the implant shoulder can be placed slightly subcrestally for better hard and soft tissue adherence (Figs. 7 and 8) . Excellent primary stability was achieved due to the implant platform and the slightly under-dimensioned drill hole, so that the implant was restored as planned. Before sealing the soft tissue, we took an X-ray to exclude any possible damage to the surrounding tissue from a forensic perspective (Fig 9) . Digital impression taking and CAD design of the hybrid crown The new scan adapter is a well-thought out technical highlight which is simply clicked onto the implant base. The Sirona scanbody is then simply attached to allow digital intraoral impression taking with the Sirona Omnicam. Following data transfer, the scan adapter including the scanbodies were removed, the gingiva former was attached and the soft tissue sutured with two positioning sutures. As some swelling of the soft tissue can be expected, this suture is sufficient to give the emergence profile of the crown, which will be placed a few hours later, sufficient space (Figs. 10 and 11) . The transferred scanning data was read and the hybrid crown fabricated on the titanium base CAD/CAM saved in the software. The screw access channel was created and the crown positioned virtually in the IPS emax ® CAD blank (Figs. 12 to 15) . Alternatively, a temporary restoration with Telio CAD is possible at this point in time. Once the hybrid construction had been milled, the carrier connections to the blank were severed and carefully ground, the crown was customized somewhat with stains and then sintered in the ceramic furnace. Option of laboratory fabrication Modern intraoral scanners provide open STL data sets, so that both the design of the reconstruction as well as the fabrication of the crown can be performed lab-side with the appropriate equipment. The treatment teams are able to communicate and interact easily and conveniently via the digital workflow. The digital solution is often an efficient approach to meet patient wishes for inexpensive solutions. Insertion of the reconstruction on the day of surgery The bonding surfaces are activated corre- sponding to the materials for bonding the crown to the iSy titanium base CAD/CAM. This means sandblasting and silanizing the titanium base and etching the crown with 5% hydrofluoric acid. The components are finally bonded with Multilink ® Implant (Ivoclar Vivadent) (Fig. 16) . A few hours later the patient came into the practice for insertion of the hybrid crown. To this end, the gingiva former was removed, the abutment screw loosened and removed, the iSy implant base was removed using the abutment disconnector. The restoration was placed on the implant which had been inserted during the morning and the screw tightened with 30 Ncm (Fig. 17) . After checking occlusion and function, the screw access channel was sealed with Teflon tape and flow composite (Figs. 18 and 19) . Discussion Workflows are often used in implant dentistry that are regarded as “gold standards”. However, daily and practiced workflows often overlook that there is sufficient evidence to allow reduced solutions for the benefit of the patient. These lead to the same, if not even better results [7] . In our dental practice I see the digital workflow as a commercial necessity to meet the demands of our patients for inexpensive solutions – and that also require fewer appointments [8 – 12] . The implementation of these technologies is of benefit to our dental practice – and can be measured in numbers. The new immediate restoration concepts drastically reduce actual “chairside times” and thus the practice costs. This way we meet patient needs in a targeted manner and improve our services continuously. The digital workflow can be implemented CASE STUDY Fig. 7: The implant is inserted using the insertion tool which is mounted on the implant base to take the implant. Fig. 8: The correct placement of the implant is checked in occlusal top view. Fig. 9: The X-ray control image shows the subcrestal placement of the iSy implant. Fig. 6: The depth and direction indicator is a useful tool for checking implant inclination. Fig. 10: The iSy scan adapter was inserted into the implant base for intraoral scanning and the scanbody snapped on. Fig. 13: The occlusal view shows the perfect positioning of the screw access channel. Fig. 11: The iSy gingiva former was attached and the soft tissue fixated with adaption sutures. Fig. 14: The design, the crown emergence profile as well as the contact points were checked carefully. Fig. 12: The transferred intraoral scan shows the surrounding soft tissue and the pyramid of the CEREC ® Scanbodies. Fig. 15: The crown design was positioned perfectly on the blank for milling. Fig. 16: Bonding of the CAD/CAM-fabricated lithium disilicate crown was performed extraorally on the titanium base. Fig. 17: The hybrid crown was placed several hours after implantation. Fig. 18: The abutment screw was retightened after removing the sutures. Fig. 19: The screw access channel was sealed with Teflon tape and a flow composite.