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Perfect Harmony in White - DENTSPLY Friadent

Perfect Harmony in White - DENTSPLY Friadent

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_08 light_28 _1 _2 _3 ENHANCED ESTHETICS WITH CERCON ® ABUTMENTS* DR. KATRIN DÖRING white_progress Now that functional stability can be achieved as a matter of routine with single implants, the past few years have been spent perfecting the esthetics re- sulting from the treatment. Today, patients demand optimum esthetics and natural looks, which is a con- siderable challenge for us surgeons, especially if single restorations are concerned. The degree of success clearly depends on how harmoniously the restoration blends in with the natural dentition, in case the patient has a high smile line. There should be a perfect match to the adjacent teeth and the contralateral reference region. The objective of our efforts is to create restorations which appear as natural as possible and are not apparent to observers. This requires that the natural crown be restored with a perfect resto- ration which mirrors the contralateral natural tooth. The shape, shade, surface structures and optical effects of the teeth are analysed in detail and reproduced artistically. Apart from this har- mony and relative symmetry, the contiguous soft tissues are also highly significant for creating natural looks. Long-term esthetics and functio- ning are based on the stability of this “dento- gingival complex”. Therefore, the mucogingival “architecture” can often only be restored by hard or soft tissue augmentation. Conventional, customizable titanium abutments could produce a metallic/bluish shimmer in case

of thin gingiva. The resulting darker shades around the gingiva may affect the esthetics no- ticeably and produce an unsatisfactory outcome, especially in patients with high smile lines. As with PFM restorations, titanium abutments can- not transmit light through crowns naturally (fig. 1). The CERCON ® abutment for the ANKYLOS ® im- plant system made of zirconium oxide, enhances the esthetic result even more. The zirconium oxide abutment has the advantage of tooth-like shades and can be customized without having to dispense with the proven conical connector between the implant and abutment which en- sures mechanical stability (fig. 2). Apart from the positive optics, CERCON ® abutments exhibit high flexural strength and fracture toughness values far in excess of those of aluminium oxide ceramics. As ceramics are highly biocompatible, the abutments are very tissue-compatible and it is known that very little plaque accumulates on them. The procedure for all-ceramic abutments is vir- tually the same as that for restorations based on ANKYLOS ® titanium Balance anterior abut- ments. After implant uncovery, the soft tissues are contoured with the correct size of sulcus for- mer. As soon as the peri-implant structures are dimensionally stable, a pick-up impression is taken to transfer the implant position to the mas- ter model. The technician selects the correct all-ceramic abutment based on the thickness of the mucosa as well as the angulation and width of the tooth being replaced. As zirconium oxide is very hard, it can only be customized by trimming with a water-cooled turbine. The all-ceramic crown is fabricated directly on the abutment and fits extremely precisely. In this case, a Procera crown was fabricated although various all-ceramic sys- tems can be used for producing the superstructure (fig. 5). The acrylic positioning template (fig. 3) is used to accurately transfer the abutment position, selected by the technician, to the patient’s mouth (fig. 4). The abutment is tightened in the implant with 15 Ncm; the titanium screw draws the conical surfaces of the abutment into the implant tightly. The screw aperture in the abutment can be sealed in advance. The patient’s high smile line requires an accurate tissue management to achieve an opti- mal esthetic outcome, using all the means availa- ble to us nowadays. The all-ceramic components provide for enhanced optics and much more natural light transmission through the restoration thus taking us a step fur- ther toward our objective of copying nature right down to the most minute detail. _4 _5 * Review of the article published in J Oral Implantol 2004;30(3): 198-209 Special thanks to Michael Krause MDT, Berlin and Dr. Dr. Michael Stiller, Berlin. light_29

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