Written by Andrew Sedler
Today implant therapy is a highly sought-after treatment option for many patients seeking alternatives to a standard three-unit bridge. Patient satisfaction is extremely important in these cases and requires the team to take the steps necessary to manage these expectations. There are many options available when restoring implants in the esthetic zone.
The esthetic zone offers special challenges.
The key to achieving the desired result is to clearly understand the goals of the restoration. One area to consider is whether to use a stock or custom abutment. Stock abutments do offer different contours and options, but these are limited. They can be used on both bone-level and tissue-level implant cases.
These abutments are usually not suited for the esthetic zone as the tissue must adapt to the shape of the abutment. This makes it challenging to achieve tissue support comparative to the adjacent teeth and an ideal emergence profile. In addition, the final crown margin is dependent on the height of the abutment and depth of the implant.
In contrast, a custom abutment will offer exceptional results in the esthetic zone in most cases. An abutment must support the peri-implant tissue to create an ideal emergence profile. Through the customization of abutments, the implant position, angulation, mesial-distal, and depth is controlled to ideally support the soft tissue.
Choosing the right abutment material will also have an impact on achieving optimal esthetic results. The abutment can affect the tissue color when the tissue is thin. Gray abutments can create an unappealing gray cast showing through the tissue. In these cases, zirconia abutments or abutments with a gold hue create a superior esthetic result. When adequate tissue thickness is present, no color shows through, allowing for more material choice options.
Once the goals are set and the plan is in place, designing and manufacturing begin. Precision manufacturing helps to elevate not only the final esthetic results but the proper fit and strength as well, to ensure a restoration that lasts. This is why Burbank Dental Lab has invested in state-of-the-art computer-aided design (CAD) and computer-aided manufacturing systems (CAM). Their implementation has led the research and development department to create Burbank Dental Lab's proprietary implant line, Smart1.
Smart1 abutments can be fabricated to support either screw-retained or cementable options. They can be used with any implant platform, allowing the clinician to use their platform of choice. Utilizing computer numerically controlled milling (CNC), each abutment is designed to create perfect emergence profiles, angles, and ideal contours. Currently, only 5% of dental laboratories utilize CNC precision milling. Smart1 implants can be milled from titanium, zirconia, or CO/CR.
Once osseointegration has occurred, digital impressions can be taken. This is done by using an appropriate scan body to digitally record the angle, height, and position of the implant. An intraoral scan of the tissue, scan body, and opposing are taken and evaluated, then sent to Burbank Dental Lab. Once received, sophisticated CAD/CAM technologies are incorporated to design the abutment to optimal specifications dictated by the emergence profile, soft tissue, and contours. This helps to create the ideal situation supporting the restorative plan.
After the abutment has been designed, the restoration will be the final step in the process. In the anterior or esthetic zone, it is critical to ensure the restoration blends within the environment. Achieving a satisfactory result that mimics natural dentition is one of the most challenging types of cases. It is for this reason that layering porcelain is the process that is most often used. Layering porcelain requires highly skilled technicians who understand tooth morphology and color and can recreate them with porcelain.
In this example (figure 3, shown below), after the abutment has been fabricated, the abutment is scanned, and a zirconia substructure is designed in the appropriate color to match the surrounding dentition. In this particular case, the tissue was thin, and it was determined that fabricating an abutment with a gold hue would be best to ensure there was no metal showing through the soft tissue. A coping was fabricated to allow room for layering porcelain to match the surrounding teeth.
With the coping designed, (Figures 4 and 5, shown below) each of the case components was ready to be manufactured. The model was printed and used for verification. The abutment and coping were milled. Next, highly skilled technicians layered the appropriate porcelains to match the implant to the surrounding dentition. (Figures 6 and 7, shown below)
Burbank Dental Lab's proprietary zirconia brand ZIRMAX.M is a strong restorative material (1000 MPa) that is 100% biocompatible. Its flexural strength makes it one of the strongest zirconia materials in the industry. It is 25% more translucent than other zirconia brands, providing better blending and more natural results.
Porcelain is added to achieve the proper contours. The anatomy, internal structures, and color are layered in to match the existing dentition.
Matching a single unit in the esthetic zone is difficult and is made even more difficult when the restoration is an implant. However, taking the proper steps to understand the case challenges, patients' concerns, and their wants and needs is critical in achieving the patient's overall satisfaction. Precision manufacturing, quality materials, and skilled technicians elevate both the process and the outcome.
Contact Burbank Dental Lab today to find out more about Smart1 implants.
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Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.
Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.
Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.
Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.
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