A clinical case by our Community member Dr. Sinan Ghishan
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
Digital impression is taking a major part in clinical dentistry. Its high precision and trueness allow us to make indirect restorations more accurate and less stressful. Longevity of indirect restorations is influenced by marginal and internal fit. The acceptable marginal gap of restorations fabricated by CAD/CAM technology is recommended to be less than 90 μm. The
same scenario is applicable for prosthesis over implant.
A PEEK coded scan abutment from Dentium was used in this case. It comes in different sizes and functions as a gingival former and impression post at the same time, and it is usually placed after surgery to reduce sessions and to eliminate the effect of screwing and unscrewing of implant spare parts on the soft tissue around the implants.
Fig.1
Implant was placed 3 months earlier with guided surgery, and the Dentium coded scan abutment was placed at the same time. Each scan abutment has a specific code that allows us to know the depth and the contour and the hex direction of the implant.
Fig.2
Proper coded scan abutment selection will lead to a conditioning of the soft tissues.
Video.1
Helios 600 from Eighteeth was chosen to take the digital impression. The emergence profile and the contact area of the adjacent teeth were smoothly scanned because of the high depth of view of this scanner, which is around 15 mm. In addition, you can see that, while scanning the opposing arch, we can easily scan the wisdom tooth because of the favorable head size of the scanner.
In this video, you can see the steps to taking a digital impression over a single implant as per the following:
1- Lower arch and implant site with emergence profile
2- Coded scan abutment
3- Upper arch
4- Occlusion
Fig.3
Mesial and distal contact areas were easily scanned thanks to the 15mm depth of view of the Helios 600 scanner.
Video.2
PLY Files were sent to the lab and 3Shape Dental System CAD software was used to design the final restoration.
Fig.4
A monolithic zirconia screw-retained crown was fabricated using a custom abutment.
Fig.5
Teflon and composite filling were later used to fill theocclusal screw hole after tightening the abutment using the ratchet at 35 N/cm.
Fig.6
Perfect fit on panoramic Xray.
Fig.7
Crown in place with a gingival contour similar to our emergence profile.
Conclusions
Intraoral scanners can bring many advantages into our daily practice, such as time saving, increasing accuracy, reducing manual errors specially in challenging cases, cutting costs and saving impression materials.
Coded scan abutment can play a magnificent role in gingival health and bone remodeling around implants.
Bibliography
- Hasanzade M, Aminikhah M, Afrashtehfar KI, Alikhasi M. Marginal and internal adaptation of single crowns and fixed dental prostheses by using digital and conventional workflows: A systematic review and meta-analysis, J Prosthet Dent. 2021 Sep;126(3):360-368. Epub 2020 Sep 12.
- Tsirogiannis P, Reissmann DR, Heydecke G. Evaluation of the marginal fit of single-unit, complete-coverage ceramic restorations fabricated after digital and conventional impressions: A systematic review and meta-analysis. J Prosthet Dent 2016 Sep;116(3):328-335.e2.
- Rutkūnas V, Gečiauskaitė A, Jegelevičius D, Vaitiekūnaset M et al. Accuracy of digital implant impressions with intraoral scanners. A systematic review. Eur J Oral Implantol 2017;10 Suppl 1:101-120
