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Our last step was to select <strong>Glidewell</strong> Laboratories as the dental laboratory in the CEREC Connect software, and complete the detailed prescription for the simultaneous fabrication of the CAD/CAM custom abutment and crown (Fig. 6). I selected a titanium abutment and BruxZir ® Solid Zirconia crown. Before the lab began the milling process, the technician called as I had requested, and we fine-tuned the design (Fig. 7). The case arrived at my office nicely packaged and organized. I tried in and verified the fit of the CAD/CAM abutment (Figs. 8, 9), torqued it to the recommended specifications, and then cemented the BruxZir ® crown with very minimal adjustment (Fig. 10). Figure 9: Radiographic verification of seating of abutment Conclusion As I have done many times, I could have handled this case in-office with good results using soft tissue models, a prefabricated titanium abutment prepared extraorally and an IPS e.max ® crown (Ivoclar Vivadent; Amherst, N.Y.), but why would I want to spend more time doing laboratory work when I have the option of being more productive and delivering state-of-the-art dentistry to my patients? When you compare the simple steps involved in capturing digital implant impressions using scannable abutments to conventional impression systems, the digital method is simpler, easier and makes you a better, happier and more productive dentist. 8 CM Dr. Carlos Boudet is in private practice in West Palm Beach, Fla. Contact him at www.boudetdds.com or 561-968-6022. Figure 10: Cemented BruxZir crown After removing the healing abutment, I placed the Inclusive Scanning Abutment and finger-tightened it over the implant (Fig 3). If tissue shaping is required for proper emergence of the final abutment because you did not use a custom healing abutment, you can do it at this time. This will give the laboratory a good idea of the desired emergence profile. The downside is that you will need good hemostasis, as any bleeding will interfere with the impression. References 1. Zweig A. Improving impressions: go digital! Dent Today. 2009 Nov;28(11):100, 102, 104. 2. Patel N. Integrating three-dimensional digital technologies for comprehensive implant dentistry. J Am Dent Assoc. 2010 Jun;141 Suppl 2:20S-24S. 3. Mörmann WH. The evolution of the CEREC system. J Am Dent Assoc. 2006 Sep; 137 Suppl:7S-13S. 4. Boudet CA. CEREC Connect: a welcomed upgrade for CEREC users. Chairside. Spring 2011;V6I2:38-44. 5. Fuster-Torres MA, et al. CAD/CAM dental systems in implant dentistry: update. Med Oral Patol Oral Cir Bucal. 2009 Mar 1;14(3):E141-5. 6. Garg AK. Cadent iTero’s digital system for dental impressions: the end of trays and putty? Dent Implantol Update. 2008 Jan;19(1):1-4. 7. Personal communication between laboratory owner and author. 8. Lee SJ, Gallucci GO. Digital vs. conventional implant impressions: efficiency outcomes. Clin Oral Implants Res. 2012 Feb 22. Article first published online. Next, we powdered the scanning abutment and adjacent teeth, and took the scans for the digital impression (Fig. 4). I then took the buccal bite and correlated (stitched) the models (Fig. 5), before replacing the scanning abutment with the healing abutment. 48 www.chairsidemagazine.com
– ARTICLE and CLINICAL PHOTOS by Leendert Boksman, DDS, BSc, FADI, FICD and Robert C. Margeas, DDS Case Report The Creation of a Soft Tissue Emergence Profile with a Long-Term Ribbond ® -THM Provisional There is an ever-increasing body of dental research literature evaluating the use of fibers to reinforce the clinical performance of dental composites and acrylics. Teeth restored with fiber posts show a significantly higher resistance to fracture than titanium 1 and stainless steel posts. 2 Teeth restored with fiber posts are significantly stronger in static and fatigue fracture testing than teeth restored with metallic posts, 3 resulting from an elastic modulus that more closely approaches dentin, producing less concentrated stress on the root. 4 Similarly, custom fiberreinforced posts (Ribbond ® [Ribbond; Seattle, Wash.]) fabricated directly into the root canal space with composite show that polyethylene fiber reinforced posts with composite cores demonstrate high survival rates and can be recommended for use. 5,6 Additionally, the insertion of Ribbond inside the cavity has a positive effect on fracture strength of endodontically treated molar teeth with MOD cavity preparation and cuspal fracture, 7 as well as the ability to reinforce severely compromised teeth which have been endodontically treated. 8 The use of fiber reinforcement has distinct advantages in traditional composite restorative techniques. The use of fiber under composite restorations can save the tooth structure by changing fracture lines if cusp failure should occur 9 and significantly increases fracture strength of MOD composite restorations, especially if placed in a buccal to lingual direction. 10 The fatigue strengths of particulate filler composite resins is 49–57 MPa, and those of fiber-reinforced composites is 90–209 MPa, with the strain of UHM- WPE (ultra-high molecular weight polyethylene, i.e., Ribbond) being the highest. 11 Strain energy absorption can be increased 433 percent over unreinforced composite, with the leno-weave reinforced composite having the highest consistency due to the details of its architecture, which restricts fabric shearing and movement during placement. 12 Polyethylene reinforcing fiber, when used in combination with a flowable resin in high C-factor cavity preparations, results in stable bond strengths and an increase in the microtensile bond strength to the dentin floor. 13 Another significant advantage of using fiber reinforcement in traditional Class II composite resins is the significant decrease in gingival microleakage. 14 The Creation of a Soft Tissue Emergence Profile with a Long-Term Ribbond-THM Provisional49
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Contents 49 Case Report: The Creati
Page 6 and 7: Letters to the Editor Dear Dr. DiTo
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 10 and 11: Numbers by the 2 26% Percentage of
Page 12 and 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 14: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 17 and 18: Photo Essay The Pursuit of BruxZir
Page 19 and 20: Figure 5: This is the shade taken f
Page 21 and 22: Figure 11: Because of the pressure
Page 23 and 24: Figure 17: On the lingual, I cut th
Page 25 and 26: Figure 23: I make my next depth cut
Page 27 and 28: Figure 29: Toward the end of the pr
Page 29 and 30: Figure 35: The next step of the Rev
Page 31 and 32: Figure 41: The bottom cord provides
Page 33 and 34: Figure 47: The BruxZir crowns fit w
Page 35: Figure 53: I fill the BruxZir crown
Page 39 and 40: Interview with Dr. Dan Fischer - IN
Page 41 and 42: give you one-fourth to one-half tha
Page 43 and 44: ourselves darn hard, it’s still n
Page 45: one job I can think of in Western c
Page 48 and 49: In late 2010, Straumann introduced
Page 52 and 53: Strassler has written extensively o
Page 54: Dr. Len Boksman formerly was direct
Page 57 and 58: SPEED DENTISTRY Fast Is Better —
Page 59 and 60: apidly would lead to more mistakes
Page 61 and 62: 7. Move faster and have your staff
Page 63: There is no one method for speed de
Page 66 and 67: centrals at the current length or s
Page 68: Retraction cord was used to gently

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