Digital implant restorations

Drs Abdelrahman Khalaf & Kirollos Hany

Thu. 9. March 2023

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With the advancement of dental implantology techniques, implant treatment has become more affordable and thus easier for patients to accept, even though implant surgery is quite an invasive procedure. In addition, an increasing number of dentists are becoming specialists in the field of dental implantology.

All these factors contribute to the flourishing of implantology and implant treatment. In the case presented in this article, the treatment was carefully planned with the aim of restoring function and correct occlusion to regions #13 and 15 with a bridge supported on two implants.

Implant insertion

Two implants (Nobel Biocare) were inserted in place of teeth #13 and 15 (Fig. 1). The next stage of the treatment was performed a few months later to ensure proper osseointegration. This increases the possibility of long-term success of the treatment.

Intra-oral scan

After ensuring that the emergence profiles were correct and the soft tissue around the implants healthy, the intra-oral scanning was performed with Aoralscan 3 (SHINING 3D) to capture the digital impression. The first step was to obtain full-arch data without scan bodies (Fig. 2), then to choose and delete gingival data around the implant, and then insert the scan bodies for intra-oral scanning (Fig. 3). The last scan recorded the occlusion data (Fig. 4). Although there was a metal crown on tooth #47, Aoralscan 3, employing the function of active scanning of metal surfaces, captured its morphology very well without additional powder spray (Fig. 5).

Figs. 2 & 3: Scan without the scan bodies attached.

Fig. 3

Fig. 4: Scan with the teeth in occlusion.

Fig. 5: Scan of the metal crown.

CAD of the restoration

The restoration was designed in exocad software (Figs. 6–8). There are many factors to consider when designing a prosthetic restoration, such as location, stress distribution of the implants, the occlusal relationship and the number of artificial teeth the implants can support—generally, two implants can support three to four artificial teeth.

Figs. 6–8: Design of the final restoration.

Fig. 7

Fig. 8

Try-in provisional restoration

DM12 resin (SHINING 3D) was used to print the model (Figs. 9 & 10) with the AccuFab-D1s printer (SHINING 3D). The printed model was used for quality inspection of the provisional restoration, which was placed in the patient’s mouth until the final restoration was ready.

Fig. 9: 3D-printed models.

Fig. 10: Scooping the models off the printing platform.

Final restoration

The final restoration was produced with monolayer zirconia. After try-in on the model (Figs. 11 & 12), the restoration was placed into the patient’s mouth. The morphology, occlusion and colour of the final restoration were satisfying, and the patient was very pleased with the final outcome of the treatment (Figs. 13–15).