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Creating Surgical Guides Using CBCT and Intraoral Scanning
Figure 18: Inclusive Scanning Abutments used for the iTero scan process
Figure 20: BruxZir screw-retained crowns, consisting of titanium base and
monolithic body
Figure 19: iTero scan software demonstrating Inclusive Scanning Abutments
at site #29 and #30
Figure 21: BruxZir screw-retained crowns with access openings revealing
titanium retention screws tightened into place
Posterior Inclusive ® Scanning Abutments for NobelReplace
RP were secured at fixture level on each NobelReplace
implant, by way of internal titanium retention screws (Fig.
18). A radiograph was taken to verify that the scanning
abutments were properly seated on the implant fixtures,
and to further aid in confirmation of osseous integration.
A mandibular full-arch scan, maxillary full-arch scan, and a
centric position of maximum intercuspation were recorded
with the iTero digital scan technology (Fig. 19). The STL
files were sent directly to Glidewell Laboratories. Using
the Abutment Designer software program (3Shape; New
Providence, N.J.) and a proprietary design library, the
virtual design of the implant crowns was completed. Two
model-less, custom-milled, screw-retained crowns were
fabricated (Fig. 20). The screw-retained crowns were made
with a titanium base to allow a titanium-to-titanium interface
between the crown and implant connection. The body of
these crowns were milled from BruxZir ® Solid Zirconia,
a high-strength monolithic ceramic material. Milling took
place in a 100 percent digital environment, without models.
The screw-retained crowns were delivered for evaluation,
and the patient was seen for try-in and delivery. The healing
abutments were removed so that the restorations could be
seated and then tightened into place (Fig. 21) using the
supplied titanium retention screws and a standard Nobel
Biocare abutment driver. A manual torque wrench was used
to tighten the titanium retention screw of implant crown #29
and crown #30 to a value of 35 Ncm. The occlusal access
holes were filled with Teflon plumber’s tape (Fig. 22) and
the access holes sealed with TPH ® 3 universal composite
resin (Dentsply Caulk; Milford, Del.) (Fig. 23). A routine
periapical radiograph confirmed an excellent interface
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