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CAD/CAM-fabricated, two-part implant rehabilitation in the front

In the anterior region, two-part abutment and crown rehabilitations are a great way to predictably shape the gingiva and achieve optimal prosthetic results. VITA ENAMIC IS hybrid ceramic blanks (VITA Zahnfabrik, Bad Säckingen, Germany) have a dentin-like elasticity. In two-part restorations, the hybrid ceramic abutment then acts as a shock absorber between the ankylotically anchored implant body and the all-ceramic crown. In the interview, Dentist Dr. Daniel Butterman (Centennial, Colo., USA) describes the esthetic and functional benefits of a two-part implant reconstruction with an abutment made of VITA ENAMIC IS and a crown of VITABLOCS TriLuxe forte.

DV: What are the advantages of a two-part, screw-retained implant reconstruction with a hybrid ceramic mesostructure and a feldspar ceramic crown?

Dr. Daniel Butterman: The combination of the force-absorbing VITA ENAMIC IS abutment with the esthetics and translucency of feldspar ceramic is a real clinical benefit for me. With it the prosthetic superstructure becomes more predictable in terms of pink and white esthetics.

DV: How do the mesostructure of VITA ENAMIC IS and a crown made from the feldspar ceramic VITABLOCS TriLuxe forte harmonize so well esthetically and functionally?

Dr. Daniel Butterman: The shade of the VITA ENAMIC IS abutment harmonizes perfectly with the polychromatic VITABLOCS TriLuxe forte crown. The translucency of the feldspar ceramic allows the warm, dentin-like color effect of the hybrid ceramic abutment to act from within.

DV: What should clinicians consider when conditioning a titanium base and hybrid ceramics in order to reliably bond all structures adhesively?

Dr. Daniel Butterman: The titanium base must be sandblasted and then conditioned with a metal primer. The adhesive surface of the VITA ENAMIC IS abutment is etched with hydrofluoric acid and then silanized. The advantage of hybrid ceramics is that the dominant ceramic network can be easily conditioned and then adhesively bonded in a proven form.

DV: How do you usually handle soft tissue management, and how can an ideally shaped emergence profile be reproducibly achieved?

Dr. Daniel Butterman: The emergence profile can be designed either as part of the surgical procedure with a temporary restoration or during exposure with a CAD/CAM-supported temporary restoration. The contours and the emergence profile can be specified as part of the computer-aided design.

DV: What are the clinical advantages of the VITA ENAMIC hybrid ceramics in treating patients with implant-supported reconstructions?

Dr. Daniel Butterman: For me, the two biggest advantages are the speed of grinding and manual preparation, which makes it possible for me to provide restorations for patients within one day. In addition, the force-absorbing properties of VITA ENAMIC help protect the implant and bone from occlusal overload.

Report 07/18

Dr. Daniel Butterman Centennial, Colorado, USA
"Pink and white esthetics will be more predictable with two-part superstructures."
Dr. Daniel Butterman
Centennial, Colorado, USA
Fig. 1: The root of tooth 12 was fractured due to overload.
Fig. 1: The root of tooth 12 was fractured due to overload.

Fig. 1: The root of tooth 12 was fractured due to overload.

Fig. 2: The bony alveolus after the extraction of incisor 12.
Fig. 2: The bony alveolus after the extraction of incisor 12.

Fig. 2: The bony alveolus after the extraction of incisor 12.

Fig. 3: A temporary crown was adhesively bonded to the adjacent tooth in order to shape and stabilize the soft tissue.
Fig. 3: A temporary crown was adhesively bonded to the adjacent tooth in order to shape and stabilize the soft tissue.

Fig. 3: A temporary crown was adhesively bonded to the adjacent tooth in order to shape and stabilize the soft tissue.

Fig. 4: Backward-planning enabled an ideal prosthetic positioning of the implant in the jawbone.
Fig. 4: Backward-planning enabled an ideal prosthetic positioning of the implant in the jawbone.

Fig. 4: Backward-planning enabled an ideal prosthetic positioning of the implant in the jawbone.

Fig. 5: An implant was inserted with the aid of a template and a gingiva former screwed on.
Fig. 5: An implant was inserted with the aid of a template and a gingiva former screwed on.

Fig. 5: An implant was inserted with the aid of a template and a gingiva former screwed on.

Fig. 6: A CAD/CAM-supported composite crown (VITA CAD-Temp) was incorporated to ideally shape the emergence profile.
Fig. 6: A CAD/CAM-supported composite crown (VITA CAD-Temp) was incorporated to ideally shape the emergence profile.

Fig. 6: A CAD/CAM-supported composite crown (VITA CAD-Temp) was incorporated to ideally shape the emergence profile.

Fig. 7: A scanbody was screwed onto the implant and the tooth shade determined digitally with the VITA Easyshade V.
Fig. 7: A scanbody was screwed onto the implant and the tooth shade determined digitally with the VITA Easyshade V.

Fig. 7: A scanbody was screwed onto the implant and the tooth shade determined digitally with the VITA Easyshade V.

Fig. 8: A VITA ENAMIC IS abutment and a polychromatic ceramic crown (VITABLOCS TriLuxe forte) were digitally designed.
Fig. 8: A VITA ENAMIC IS abutment and a polychromatic ceramic crown (VITABLOCS TriLuxe forte) were digitally designed.

Fig. 8: A VITA ENAMIC IS abutment and a polychromatic ceramic crown (VITABLOCS TriLuxe forte) were digitally designed.

Fig. 9: The feldspar ceramic crown and the VITA ENAMIC IS mesostructure immediately after grinding.
Fig. 9: The feldspar ceramic crown and the VITA ENAMIC IS mesostructure immediately after grinding.

Fig. 9: The feldspar ceramic crown and the VITA ENAMIC IS mesostructure immediately after grinding.

Fig. 10: An ideal emergence profile became visible after removal of the temporary crown.
Fig. 10: An ideal emergence profile became visible after removal of the temporary crown.

Fig. 10: An ideal emergence profile became visible after removal of the temporary crown.

Fig. 11: The scallop-shaped gingival curve harmonized precisely with the VITA ENAMIC IS mesostructure.
Fig. 11: The scallop-shaped gingival curve harmonized precisely with the VITA ENAMIC IS mesostructure.

Fig. 11: The scallop-shaped gingival curve harmonized precisely with the VITA ENAMIC IS mesostructure.

Fig. 12: Result: The treatment result with the highly esthetic, monolithic feldspar ceramic crown.
Fig. 12: Result: The treatment result with the highly esthetic, monolithic feldspar ceramic crown.

Fig. 12: Result: The treatment result with the highly esthetic, monolithic feldspar ceramic crown.

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