Prosthetic implementation of the restoration of a right maxilla incisor with a NobelActive RP implant 15 September 2015
Clinical situation. Temporisation phase (screw-retained resin tooth)
Author: Jean-Marc Etienne
The article presents the prosthetic implementation of the restoration of a right maxilla incisor with a NobelActive RP implant.
Surgery: Dr Hadi Antoun
Prosthetist: Dominique Maréchal & lab work CERALOR Oral Design Center Nancy, Jean-Marc Etienne
Website: www.oraldesign.fr
Photo 1: Clinical situation. Temporisation phase (screw-retained resin tooth)
Photos 2 and 3: State of the peri-implant tissue. Stabilisation of the mucogingival alveolus with the help of the provisional prosthesis.
Photos 4 and 5: Digital photos are processed for the topographical survey of the shades (the temporary tooth is removed and the shade guide is placed in the alveolus and on the same photographic level as the adjacent teeth).
Here 2 samples are selected: 2C Vivodent PE (resin shade guide)
4R 2,5 Vita 3D Master.
It is important to communicate the basic hues to the prosthesist as this is essential for his work, especially for the choice of the dentine, their saturation, their luminosity...
Of course, further photographs complete this information with other details, such as cracks, abrasions, punctual chromatic effects, palatal surface...
Customisation of the impression coping, carefully recording the profile of the transgingival cone to the diameter of the future prosthesis.
Photo 10: The plaster master model made from the casting of this impression.
Photo 11: Creation of the silicone buccal flange (Gingifast rigid-Zhermack) respecting the design of the calibrated profile.
Photos 12, 13: According to the final project (WaxUp, provisional), NobelProcera® Zircone framework is crafted in the laboratory (scan & 3D design). Our common choice naturally goes to an "ASC" (Angulated Screw Channel) all-ceramic system, that is to say a screw-retained crown in zirconia stratified in ceramic with a titanium adapter which effectively guarantees the CC connection with the implant.
This adapter is fixed on the zirconia cap (without bonding) and the transfixing screw assembles it all at the time of final screwing (see photo 18)
Photo 15: Situation of the framework next to the final project materialized by the silicone index.
Photos 16 and 17: The emergence profile and the cervical part of the restoration are stratified using carefully chosen "SP" masses (Shoulder Porcelain). Moreover, these are fluorescent ceramic masses; a big asset for areas with little light (especially the cervical proximal parts).
Note: The emergence profile and the cervical part of the restoration are stratified using carefully chosen "SP" masses (Shoulder Porcelain). Moreover, these are fluorescent ceramic masses; a big asset for areas with little light (especially the cervical proximal parts)
The choice of cosmetic material is essential to a successful integration.
Photo 18: Detail of the reconstruction
Titanium adapter + screw
Zirconia emergence profile from the calibration of the impression coping
Morphological prolongation of the cosmetic material (created by ZI CT- Willi Geller)
Photo 19: An advanced biscuit is used for clinical fitting.
First observation: the cervical emergence profile is slightly too compressive
Excessive chromatic saturation on 1/3 of the cervical.
Photos 20/21: Optimisation of the emergence profile with a light surfacing on-site.
Photos 22/23: Altered biscuit A new dental impression is made for the laboratory.
Photos 24, 25, 26: On the newly obtained model, finishing off of the shapes, textures, emergence profiles, and a few chromatic alterations.
Photos 27/28: Final fitting, implant placement.
The requirements have been respected in the prosthetic choices, profiles and axes management and in the suggested prosthesis.
The maxillary central incisor remains a great challenge when the two entities at hand are located several hundred kilometres apart, practice in Paris/laboratory in Nancy.
