Yes! I want to learn more about true same-day implant restorations.
A multi-part presentation demonstrating the effectiveness of restoring an implant restoration with VITA ENAMIC IS.
Dr. Daniel Butterman
Most of us purchased CEREC to deliver high quality single-visit dentistry. This was not practical to do for restoring implants due to the long processing time of the available materials. Now, with the introduction of VITA ENAMIC IS, we have an excellent restorative material that can be delivered easily in a single crown appointment.
Part 1: Case Presentation
A 38-year-old healthy male with an unremarkable medical history, presented with a non-restorable tooth #19. The tooth had a vertical root fracture and recurrent decay. The patient was given an option for an implant at site #19 or a fixed bridge from teeth #18-20. The patient elected to have the tooth extracted and an implant placed immediately at the time of extraction.
Part 2: Implant Placement
The clinical crown was sectioned off and the initial osteotomy was performed through the furcation of the tooth to keep the implant centered. The roots of #19 were then removed atraumaticaly, and the osteotomy was completed. A 5 x 10 mm Implant Direct Interactive implant was placed and torqued to 40 Ncm. The site was grafted with a cortico-cancellous mix of DFDBA bone and sutures were placed. The site was allowed to heal for 3 months, at which time the patient returned for his final restoration.
What material should be considered for this restoration?
Part 3: Material Selection & Design
The case was set up in administration of CEREC for a multi-layer crown using VITA ENAMIC IS. I chose ENAMIC IS because it processes quickly and no oven is needed. It can be used to restore an implant in a single visit, in approximately the same amount of time as it takes to fabricate a crown for a natural tooth. Contacts or occlusion can be added to ENAMIC with composite even after it is bonded to the tibase. No alteration is possible to e.Max, or any other material that needs to be fired in an oven. Another advantage is that color can be added to ENAMIC IS directly in the mouth. Due to the resiliency of the material, it may help distribute occlusal forces away from the screw and crestal bone.
I always set up my case in administration as a multi-layer abutment case, even if I plan on screw-retained. Setting it up as a screw-retained case doesn’t allow you to change your mind if you decide to split it if you have screw access hole position issues or insertion problems due to the implant angle. You would have to change it in administration and lose the design. By setting it up as multi-layer, you can do a screw-retained case by advancing to mill and not splitting the case.
- Select ENAMIC IS as the material.
- Select the appropriate ti-base for implant brand and platform size.
- Always use a scan post to image the implant platform and timing.
A gingival mask scan, upper jaw, buccal bite, and lower jaw scan were performed using a NBA 5.0L scan post and scan body. This step takes about 15 minutes.
Tips when imaging:
- Make sure the scan post is fully seated on the implant and verify with an X-ray.
- For a screw-retained crown, it is best to place the scan post notch interproximally because the sprue will mill 90 degrees from the notch. For an abutment, notch position is not an issue because the software will position it using different criteria.
- Make sure scan body is correctly seated over notch of scan post.
- The shiny scan post may be difficult to scan. Focus on scanning the area where the scan post meets the gingiva. If you do not have enough scanned data, the software may assume the scan post is an artifact and remove it from the image.
- Before dismissing the patient, always move forward to making the models step to confirm that all imaging is accurate.
Conclusion: Finishing and Placement
The restoration was microetched, treated with 5% hydrofluoric acid, silanated and bonded to the ti-base with Scotchbond Universal adhesive and RelyXTM Ultimate opaque cement (10 minutes). Note that the manufacturer recommends Multilink® Hybrid Abutment cement, but this requires a 7 minute self cure. A light cure material was selected instead.
The abutment crown was torqued into the implant, contacts and occlusion were checked with no adjustments necessary, and Teflon placed into the screw access hole. Composite was placed to close the access and the patient was dismissed (15 minutes).
Conclusion: Total time from patient being seated to dismissal was an hour and twenty-five minutes, arguably faster than it takes to fabricate an e.Max® crown for a natural tooth at a significantly higher profit margin.