Tạp chí Implant tháng 10 2013 vol 6 no5

clinical articles • management advice • practice profiles • technology reviews

PROMOTING EXCELLENCE IN IMPLANTOLOGY

Legacy™4 Implant
A Legacy of Innovation

October 2013 – Vol 6 No 5

Corporate profile
Carestream Dental

Missing lateral
incisors: overcoming
the problem of
insufficient space
Dr. Ian Hallam

Practice profile
Dr. Robert J. Miller

Product profile
BIOMET 3i launches its
new 3i T3® Implant

CAD/CAM anterior
esthetic implant
restorations
Dr. Dean Vafiadis

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are registered trademarks of ZEST IP Holdings, LLC.


EDITORIAL ADVISORS
Steve Barter BDS, MSurgDent RCS
Anthony Bendkowski BDS, LDS RCS, MFGDP, DipDSed, DPDS,
MsurgDent
Philip Bennett BDS, LDS RCS, FICOI
Stephen Byfield BDS, MFGDP, FICD
Sanjay Chopra BDS
Andrew Dawood BDS, MSc, MRD RCS
Professor Nikolaos Donos DDS, MS, PhD
Abid Faqir BDS, MFDS RCS, MSc (MedSci)
Koray Feran BDS, MSC, LDS RCS, FDS RCS
Philip Freiburger BDS, MFGDP (UK)
Jeffrey Ganeles, DMD, FACD
Mark Hamburger BDS, BChD
Mark Haswell BDS, MSc
Gareth Jenkins BDS, FDS RCS, MScD
Stephen Jones BDS, MSc, MGDS RCS, MRD RCS
Gregori M. Kurtzman, DDS
Jonathan Lack DDS, CertPerio, FCDS
Samuel Lee, DDS
David Little DDS

Andrew Moore BDS, Dip Imp Dent RCS
Ara Nazarian DDS
Ken Nicholson BDS, MSc
Michael R. Norton BDS, FDS RCS(ed)
Rob Oretti BDS, MGDS RCS
Christopher Orr BDS, BSc
Fazeela Khan-Osborne BDS, LDS RCS, BSc, MSc
Jay B. Reznick DMD, MD
Nigel Saynor BDS
Malcolm Schaller BDS
Ashok Sethi BDS, DGDP, MGDS RCS, DUI
Harry Shiers BDS, MSc, MGDS, MFDS
Harris Sidelsky BDS, LDS RCS, MSc
Paul Tipton BDS, MSc, DGDP(UK)
Clive Waterman BDS, MDc, DGDP (UK)
Peter Young BDS, PhD
Brian T. Young DDS, MS
CE QUALITY ASSURANCE ADVISORY BOARD
Dr. Alexandra Day BDS, VT
Julian English BA (Hons), editorial director FMC
Dr. Paul Langmaid CBE, BDS, ex chief dental officer to the Government
for Wales
Dr. Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in-chief Private
Dentistry
Dr. Chris Potts BDS, DGDP (UK), business advisor and ex-head of
Boots Dental, BUPA Dentalcover, Virgin
Dr. Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St
referral implant surgeon

PUBLISHER | Lisa Moler

Email:

Tel: (480) 403-1505

MANAGING EDITOR | Mali Schantz-Feld
Email:

Tel: (727) 515-5118

ASSISTANT EDITOR | Kay Harwell Fernández
Email:

Tel: (386) 212-0413

EDITORIAL ASSISTANT | Mandi Gross
Email:

Tel: (727) 393-3394

DIRECTOR OF SALES | Michelle Manning
Email:

Tel: (480) 621-8955

NATIONAL SALES/MARKETING MANAGER
Drew Thornley
Email:
Tel: (619) 459-9595
PRODUCTION ASST./SUBSCRIPTION COORD.
Lauren Peyton

Email:
Tel: (480) 621-8955

MedMark, LLC
15720 N. Greenway-Hayden Loop #9
Scottsdale, AZ 85260
Tel: (480) 621-8955
Fax: (480) 629-4002
Toll-free: (866) 579-9496 Web: www.implantpracticeus.com
SUBSCRIPTION RATES
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Shifting trends: osseointegration
to peri-implant esthetics

T

he implant world is rapidly evolving. Final restorative seating of cases with a
more natural look with scalloped tissues is the newest, fastest growing trend in
implantology. The implant field has progressed: we no longer discuss modification
of the implant surface to promote osseointegration; more focus is on the soft tissues
surrounding the implant. The focus is now on maintaining tissue height, contour, and
esthetics by using surgical techniques or by using implant surface modifications such as
Laser-Lok® (BioHorizons®) or platform switching.

“This is clearly the focus of implant dentistry today. Crestal bone preservation at
the head of the implant. Platform switching, slopping shoulder, laser microchannels and

microgrooves are the predominant macro and micro geometries currently discussed,”
according to Maurice Salama, DDS.

Implants have been shown to be successful in the treatment of multiple restorative
needs: replacing single teeth, multiple teeth, or a full mouth of teeth with fixed or
removable restorations. Technology and research have improved to modify the surfacing
of the implant to help increase bone-to-implant contact, decrease healing times, and
improve the long-term restorability of implants. Initial research was first focused on
the integration of titanium to bone, and long-term followup was needed to show if this
therapy was a good treatment option for patients. Today, we have over 50 years of
research to show that implants integrate with bone and have long-term success rates.
We also have the benefit of state-of-the-art technology, like CBCT imaging, and improved
surgical techniques, such as guided surgery, to remove much of the guesswork from
procedures, and aid in the success rates of implant therapy and placement. Due to this
paradigm shift in the implant world from simply getting implants to work to emphasizing
esthetic outcomes, there has been a change in the focus of implant dentistry from
osseointegration to peri-implant esthetics.

Proper soft tissue development is of the utmost importance to today’s clinicians,
because it improves both the peri-implant esthetics of the final case and also the longterm stability of implants. Prior to implant placement, the soft tissue can be modified,
using one of many techniques, to promote proper tissue contour.

There are different ways of improving the peri-implant tissue. It can be achieved
by grafting with soft tissue or alloderm, modifying the amount of keratinized tissue with
various surgical techniques, or developing the soft tissue scallop/papilla around an
anterior tooth before making the final crown.

The long-term esthetic success of an implant is dependent upon maintenance of the
implant by the doctor to help avoid infection that could lead to failure of the implant. This
is done by properly placing implants in the correct position, and secondly, by properly

restoring implants. Clinicians should always avoid concave pontics, ridge-lapped crowns,
and open contacts. These make it hard for patients to clean and maintain, ultimately
leading to complications such as peri-implantitis. Getting the patients invested in the
hygienic care of their implant can also help mitigate potential issues before they become
big problems that can threaten the success of the implant.

Integration of implants has proven to be successful long term, but in a still-developing
field, there remains a need for more research to develop the soft tissue around implants.
Dentists placing implants need to be more concentrated on how to properly develop
tissue in order to avoid complications in the future. Using what we learned yesterday, and
focusing on research today, will give us better outcomes tomorrow.

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© FMC 2013. All rights reserved.
FMC is part of the specialist
publishing group Springer
Science+Business Media. The publisher’s written consent must be
obtained before any part of this publication may be reproduced in
any form whatsoever, including photocopies and information retrieval
systems. While every care has been taken in the preparation of this
magazine, the publisher cannot be held responsible for the accuracy
of the information printed herein, or in any consequence arising from
it. The views expressed herein are those of the author(s) and not
necessarily the opinion of either Implant Practice or the publisher.

Volume 6 Number 5

Daniel Domingue, DDS, FICOI, MICOI, DICOI, ASAAID, FAAID, DABOI

Mentor/Lecturer: Rocky Mountain Dental Institute, Denver, Colorado
Lecturer: Implants in Black and White, Lafayette, Louisiana

Implant practice 1

INTRODUCTION

October 2013 - Volume 6 Number 5


TABLE OF CONTENTS

Clinical

Practice profile

6

Dr. Robert J. Miller: Setting the bar high
This clinician discusses the true joy of treatment success and his recipe for
delivering high quality care in a predictable fashion.

CAD/CAM anterior esthetic
implant restorations: the
BellaTek Encode healing
abutment and CADBlock
ceramics
Dr. Dean Vafiadis delves into the use
of a coded healing abutment....... 12
Restoring the edentulous maxilla

Dr. Ross Cutts discusses a
cost effective way to restore the
edentulous upper arch................. 20
Bridge construction in the
anterior tooth area of the maxilla
Dr. Steffen Wolf juggles esthetic
requirements to produce pocketfriendly results for a patient with very
particular needs .......................... 26

Case study
Hybrid dentures provide a

Corporate profile

8

practical solution
Dr. Daniel Domingue illustrates a
case treated with fixed-detachable
dentures...................................... 30

Carestream Dental
This company continues to develop imaging systems and software and enter
new markets.

2 Implant practice

Volume 6 Number 5

TABLE OF CONTENTS

Continuing
education
Missing lateral incisors:
overcoming the problem of
insufficient space
Dr. Ian Hallam presents a case study
providing a solution for a patient who
does not wish to undergo orthodontic
treatment, using narrow implants...34
Dental rehabilitation of a 6-yearold boy with a rare tumor of the
mandible
Drs. T. Nyunt, K. George, H. Chana,
and G.I. Smith discuss treatment and
maintenance of an unusual
pediatric case................................40

On the horizon
“Lok”-ed and loaded
Dr. Justin Moody explores Laser-Lok
implant technology........................44

Technology
CBCT and implants: the new era in
treatment planning and diagnosis
Dr. Randolph Resnik discusses the
benefits of 3D imaging in a modern
implant practice ............................46

Industry news

46

CBCT and implants: the new era in
treatment planning and diagnosis

Implant essentials

Product profile

The big debate
Drs. Michael Norton and Julian
Webber discuss — implants or
endodontics?................................50

BIOMET 3i launches its new 3i T3®
Implant ........................................58

Practice
development

GALILEOS® Comfort Plus by
Sirona ..........................................60

Diary.......................................62

Apply current tax laws to improve
patient care

Bob Creamer explains Section 179
and Bonus Depreciation................54

Osteogenics Biomedical to
host 2014 Global Bone Grafting

Practice
management

Symposium in Scottsdale, Arizona
World-renowned speakers showcase
latest in bone grafting techniques,
materials, and research.................48

Materials &
equipment .....................63

Growing the money tree
William H. Black, Jr. discusses the
financial advantages of having a good
plan in place..................................56

4 Implant practice

Volume 6 Number 5


The comprehensive offering
includes the ANKYLOS®,
ASTRA TECH Implant System™

and XiVE® implant lines, digital
technologies such as ATLANTIS™
patient-specific abutments,
Symbios ™ regenerative bone
products and professional
development programs.

We are dedicated to continuing the
tradition of DENTSPLY International,
the world leader in dentistry with
110 years of industry experience,
by providing high quality and
groundbreaking oral healthcare
solutions that create value for
dental professionals, and allows
for predictable and lasting implant
treatment outcomes, resulting in
enhanced quality of life for patients.

We invite you to join us on our journey to redefine implant dentistry.
For more information, visit www.dentsplyimplants.com.

Facilitate™
www.dentsplyimplants.com

79570-US-1307 © 2013 DENTSPLY International, Inc.

DENTSPLY Implants is a leading provider
of comprehensive implant solutions that
allow for successful long-term outcomes.

PRACTICE PROFILE

Dr. Robert J. Miller
Setting the bar high
What can you tell us about your
background?
I am a graduate of Hobart College in
Geneva, New York where I earned a BS in
Chemistry. I received my DMD at the Henry
M. Goldman School of Dentistry at Boston
University. I also did my residency in
Periodontics at Boston University, receiving
a CAGS (Certificate of Advanced Graduate
Study). I have been in private practice since
1986 in Plantation, Florida.

Is your practice
implants?

limited

to

No, we also offer all phases of periodontal
therapy, including regenerative therapy,
mucogingival surgery, and anterior esthetic
procedures. When I was a resident, implant
dentistry was still not widely accepted and

was not part of the curriculum. As a result
of my early training, when confronted with
a compromised tooth, my instinct is to try
save it. I believe that this is an advantage,
as comprehensive treatment has to include
salvaging teeth whenever it is appropriate.

Why did you decide to focus on
implantology?
I received my first training in implant
placement in 1987. This course changed
the way I viewed dentistry. For the first time,
there was a predictable option for tooth
replacement. Taking this course opened
my eyes to what I perceived as cutting
edge and the future of dentistry. With this
in mind, I ultimately dedicated myself and
my practice to providing state-of-the-art
implant therapy to my patients. At some
point, I recognized that many patients
who would like implant therapy were not
necessarily candidates due to anatomical
limitations. This was an impetus to work
towards focusing on restorative-driven
implant solutions versus surgically-driven.
Guided bone regeneration soon became
the focus of the practice, and is still a large
part.

How long have you been

practicing, and what systems do
you use?
I began private practice in 1986 and placed
6 Implant practice

my first dental implants in November
of 1987. This patient still returns for
periodontal maintenance, and I am proud
to say that the original prosthesis is still
in position. I have used several systems
through the years, including the original
NobelPharma system for approximately 10
years. I switched to Straumann® in 1998,
which I have been using exclusively for the
past 13 years. This system provides me
with all the surgical and restorative options
that are necessary for state-of-the-art
implant rehabilitations.

What
training
undertaken?

have

you

I have taken many courses through the
years, including the NobelPharma surgical
certification course at Boston University

in 1987. Early on, there were very few
comprehensive courses, and learning was
more a function of groups of people getting
together and discussing the various issues
facing implant surgery and restoration.
As implant dentistry evolved, certain
individuals began to separate themselves
as the true leaders and innovators in the
profession. These included Drs. Ron
Nevins, Dennis Tarnow, Burt Langer,
and Alan Meltzer. These people were
instrumental in my early training in surgical
placement. More recently, I have had the
opportunity to take the Masters Level Bone
Grafting course with Dr. Danny Buser at
the University of Bern, Switzerland. There
are many people who have been part of the
evolution of implant dentistry, and I would

like to think that the next 27 years will be
equally as exciting.

Who has inspired you?
I have had many people inspire me through
the years; however, as a resident, there
are two people who come to mind. Drs.
Steve Pollins and Simao Kon each had a
hand in helping me to develop a practice
philosophy and setting the bar high. As a
periodontal resident at Boston University,

they would spend hours discussing cases
and aspects of treatment for which they
were passionate. I learned from them the
true joy of treatment success and a recipe
to deliver high quality care in a predictable
fashion.

What is the most satisfying aspect
of your practice?
I often say that my practice is primarily
composed of my “friends” coming to “my
house” to visit me. Having been in practice
for 27 years, I have many patients who
have been part of the “family” for a number
of years. It is extremely gratifying to have
patients return to the office for periodontal
maintenance who have had their implant
rehabilitations functioning for over 20 years.

Professionally, what are you most
proud of?
I am most proud of becoming a Fellow of
the ITI (International Team of Implantology).
Attaining this goal was a culmination of a lot
of hard work and dedication. Five years ago,
with the urging of my close friend Dr. Jeff
Volume 6 Number 5


have been an option. However, as they

say, don’t give up your day job!

What do you think is unique about
your practice?

What is the future of implants and
dentistry?

One of the nicest parts of our practice is
the fact that we have four hygienists who
have each been working in our office no
less than 20 years. Patients continually
remind me how comforting it is to see the
same familiar faces. My surgical assistant
has been with me for 15 years, making her
truly my right hand.


I am extremely excited about the future of
implants and dentistry. I see restorative
dentistry moving more towards CAD/CAM
restorations comprised of materials that
are even more esthetic. Ultimately, dentists
who are not involved in digital dentistry
are being left behind. As far as the future
of dental implants per se, I feel that there
will be a push towards robotic implant
placement removing human involvement.
In the short term, with the advent of zirconia
dental implants, the concept of custommilled dental implants may get some

traction. However, due to the fact that
these are medical devices, FDA approval
will be an uphill battle, making the concept
very difficult to get off the ground.

What has been your biggest
challenge?

My biggest challenge to date has been
incorporating the new technologies in
our office in a cost-effective and efficient
manner. Dentistry changes every 6
months, particularly from a technological
perspective, but in the end, they may not
be adding value to our practices. Weeding
through technology that is relevant and
appropriate for my practice has been an
ongoing challenge; however, this is never a
chore as I have always embraced change
and innovation.

What would you have become if
you had not become a dentist?
More than likely I would have worked with
my father in the dress business. However,
as I have been more involved in product
development, I have a lot of respect for
biomedical engineers. As I learn more
about their importance in the medical
device industry, I find myself more intrigued

with this profession. Perhaps this would

What are your top tips for maintaining a successful practice?
The best tip that I can give is to empathize
with patients. I firmly believe that one should
keep the Golden Rule in mind, which is,
“One should treat others as one would like
others to treat them.” If you use this as your
mantra while treatment planning, you will
always have the patient’s best interest in
mind. This translates to patient satisfaction
that results in a successful practice.

you to choose your cases carefully, as
there is no worse feeling than failure. Often,
less experienced clinicians will undertake
procedures that may be too advanced
for their experience level, resulting in an
undesirable outcome. This results in a
black eye for both the clinician and the
profession as a whole. I also strongly
suggest that less experienced clinicians
should hitch their star to a surgical or
restorative mentor and should also seek
out top quality companies, as this is an
area that one shouldn’t compromise. If
clinicians undertake procedures that are
within their comfort zone using high quality
materials, there is no reason that they
should not enjoy success.

What are your hobbies, and what
do you do in your spare time?
My favorite hobby is skiing. However,
for a South Florida resident, it becomes
logistically difficult. I try to ski on average
10 to 15 days a year, which is admirable
for the geographically challenged. Other
hobbies include squash, photography, fly
fishing, yoga, and working out.

Top Favorites
1. A nice sinus graft
2. My i-CAT
3. Straumann Dental Implant
System
4. Single Malt Scotch
5. Good initial stabilization
6. A “white out” at Ajax Mountain
7. Quiet time with my family
8. Finishing a bike ride up Maroon
Bells
9. New attachment!
10. Salmon roll with brown rice
11. Downshifting into third gear and
accelerating in an open road!

What advice would you give to
budding implantologists?
My advice to budding implantologists

would be to find a mentor who can help

Volume 6 Number 5 Implant practice 7

PRACTICE PROFILE

Ganeles, I began to pursue the fellowship,
which requires a high level of activity in
education, research, or leadership. It was
at that time I decided to take advantage
of publishing opportunities and went on
staff as a Courtesy Appointment with the
Community Based division program at the
University of Florida Hialeah Dental Clinic.
Becoming a Fellow of the ITI has opened up
many doors and continues to be a source
of inspiration and resources for education
and leadership.


CORPORATE PROFILE

A history of proven technology, a future dedicated to innovation

W

ith roots that can be traced back to
the 19th century, Carestream Dental
certainly has a long history of innovation
when it comes to dental specialties—

including implantology. This legacy carries
on still, as the company continues to
develop imaging systems and software
and enter new markets. It’s because of this
proud tradition that more than 800 million
images are captured each year on products
from the company’s imaging portfolio.
Today, Carestream Dental is focused on
providing implantologists with the products
they need to facilitate treatment planning
and improve patient care.

History of Carestream Dental
The Carestream Dental of today was
built on the shoulders of major industry
leaders of the past — starting in 1896
when Eastman Kodak introduced the first
photographic paper designed specifically
for dental X-rays. As technology improved
and became more digitalized, Trophy
Radiologie filed a patent for the world’s
first digital intraoral sensor in 1983. Already
known for producing intraoral X-ray
generators, the digital intraoral sensor
earned Trophy a reputation as the world’s
leader in dental digital radiography.

In 2000, PracticeWorks emerged as a
dominant dental software company when it
acquired several other software companies.

PracticeWorks went on to acquire Trophy
Radiologie in 2002, and was purchased
the next year by Eastman Kodak to expand
its presence in the dental business. With
the integration of PracticeWorks/Trophy,
Eastman Kodak built the industry’s leading
portfolio of film, digital imaging systems,
and practice management software. Then,
in 2007, Onex Corporation purchased
Kodak’s Health Group, and Carestream
Dental was born.

The Carestream Dental Factor
“We exist to make your practice better,”
said Marc Gordon, Carestream Dental’s
General Manager, U.S. Equipment and
Software. “Our number one goal is to make
user-friendly, yet sophisticated, technology
to put our customers’ practices at the
forefront.”
8 Implant practice

3D Symposium

Carestream Dental’s dedication to
advancing implantology can be summed
up by the Carestream Dental Factor; three
pillars on which the company bases all of its
products and services.  Incorporating the
key elements at the heart of Carestream

Dental’s philosophy, the company’s main
focus is on delivering diagnostic excellence,
workflow integration, and humanized
technology.
Workflow integration: Administrative
tasks cut into time that can be better spent
communicating with and treating patients.
For this reason, Carestream Dental
designs systems and software to enhance
treatment planning and fit seamlessly into
busy implant practices. Ensuring that every
link in the chain fits and contributes to the
workflow as a whole allows implantologists
to increase productivity and efficiency.

Intuitive technology and software are
the hallmarks of Carestream Dental. By
developing imaging systems that can be
quickly utilized by practitioners — and are
even compatible with third-party products
— implant specialists can eliminate time
that would have been spent troubleshooting
problems and instead focus on patients.
Humanized
technology:
Patients
are an integral part of every implant

practice, so Carestream Dental is
committed to providing solutions that

facilitate communication between the
implant specialist and patient. When
communication is optimized, patients are
happier and healthier — allowing them
to make better, more informed decisions
regarding their proposed treatment plan
and, in turn, increasing case acceptance.
Diagnostic excellence: When evaluating
sites for implant placement, details are
everything. To facilitate faster, more
reliable implant planning, Carestream
Dental has created a number of cuttingedge diagnostic tools that enable implant
specialists to capture sharp, high-quality
images quickly. From industry-leading
3D imaging systems to high-resolution
intraoral sensors, Carestream Dental offers
a range of solutions that allow practitioners
to identify areas of concern and determine
the best course of action.

Technology
developed
clinicians, by clinicians

for

The Carestream Dental Factor isn’t the only
thing driving user-focused and innovative
products, and services — the clinicians at
the heart of the company also play a large

role. Through meetings and forums with
doctors in the field, Carestream Dental
Volume 6 Number 5


It’s amazing what a great image can
do for your practice.
The CS 9000 3D and CS 9300 Select are
ready to work hard for your practice.
These technologically advanced systems will finally give you clarity, flexibility
and, most importantly, complete control of your image quality and dosimetry.
It will also show your patients how dedicated you are to their dental health.
• Optimize your image quality and dosimetry
• Make accurate assessments, diagnoses and treatments
• Experience seamless integration
• One system for superior 3D exams, 2D panoramic scans and
optional one-shot cephalometrics

To learn more about what a great image can do for your practice,
visit carestreamdental.com/3DIP or call 800.944.6365 today.

© Carestream Health, Inc., 2013

9438 DE AD 0713


CORPORATE PROFILE

Implant planning

Implant planning with software

is better able to understand the needs of
implant specialists in order to develop —
and modify — products. In fact, the voice
of the customer (VOC) is critical throughout
the development process.

To ensure quality, Carestream Dental
also keeps tight control over the products
they develop. “We are the only company that
is designing its own practice management
software and imaging equipment,” said
Mr. Gordon. “By controlling every step in
the process — from development and
manufacturing all the way to support — we
make it easier for implantologists to deliver
better patient outcomes.”

Innovative products to facilitate
implant planning
Implant specialists require high-resolution
images to evaluate the implant site, and
Carestream Dental certainly delivers. The
following is just a sample of the imaging
products Carestream Dental has designed
to meet the specific needs of implant
practices:
CS 9300: As a two-in-one unit (or threein-one, for doctors who choose the
cephalometric option), the CS 9300

allows users to select from panoramic
and cone beam computed tomography
(CBCT) imaging. Users can also choose
from seven selectable fields of view for the
Premium model (ranging from 5 cm x 5 cm
to 17 cm x 13.5 cm) and four selectable
fields of view for the Select model (5 x 5
cm to 10 x 10 cm) to tailor their image
10 Implant practice

based on the specific clinical application.
And, the system features Intelligent Dose
Management for greater control over
patient exposure.
CS 3D Imaging Software: Included
with Carestream Dental’s CBCT imaging
units, CS 3D Imaging Software allows
practitioners to view images slice by slice
in axial, coronal, sagittal, cross-sectional
and oblique views to enhance diagnostic
interpretation. In addition, the software
includes two sophisticated implant
planning modules so users can select
from a comprehensive library of implant
manufacturers or create their own custom
implant sizes.
RVG 6100: With greater than 20 lp/
mm resolution per image, Carestream
Dental’s RVG 6100 sensors deliver the
highest image resolution in the industry.

Each sensor undergoes rigorous testing to
provide maximum durability and flexibility,
and the RVG 6100 features a rear-entry
cable, three different sizes, and rounded
corners to improve comfort for patients
and make positioning easier for users.

Comprehensive education
When implant specialists understand how
to fully maximize their imaging capabilities,
they are better able to get the most of
out of their equipment. For this reason,
Carestream Dental is committed to
providing thorough training and education
to ensure their customers have the skill and

knowledge necessary to use their imaging
products and software.
In addition to providing web-based
and in-person training, Carestream Dental
holds 3D Symposiums, where dental
practitioners can learn how to use 3D
imaging equipment in their daily practice.
This event features leaders in the industry
who share advice and insights, as well as
information on the latest industry trends in
3D, to make participants’ practices more
efficient and successful.

Next steps

With the launch of CS Solutions, a oneappointment CAD/CAM restoration system,
Carestream Dental will once again enter an
entirely new market—and it certainly will
not be the last. As an integrated, openarchitecture system, practitioners can scan
an impression with a CBCT unit or scan the
patient’s mouth directly with the CS 3500
intraoral scanner, design the crown, inlay,
or onlay using the CS Restore software,
and mill the crown in-office with the CS
3000 milling machine. For doctors who
would rather send the design or milling
off to the lab, they can easily submit the
information electronically to their dental lab
of choice.
As always, Carestream Dental will
continue to focus on customer service.
“Our number one goal is to provide superior
customer experience through best-in-class
products and best-in-class support,” said
Mr. Gordon.
To learn more about Carestream
Dental’s portfolio of imaging products and
software for implant practices, please call
800-944-6365 or visit carestreamdental.
com today.
This information was
Carestream Dental.

provided

by

Volume 6 Number 5


Introducing the

Preservation By Designđ
ã Contemporary hybrid surface design with a
multi-level surface topography
• Integrated platform switching with as little as
0.37mm of bone recession*1
• Designed to reduce microleakage through
exacting interface tolerances and maximized
clamping forces

For more information, please contact your local
BIOMET 3i Sales Representative today!
In the USA: 1-888-800-8045
Outside the USA: +1-561-776-6700
Or visit us online at www.biomet3i.com
1. Östman PO†, Wennerberg A, Albrektsson T. Immediate Occlusal Loading Of NanoTite™
PREVAIL® Implants: A Prospective 1-Year Clinical And Radiographic Study. Clin Implant
Dent Relat Res. 2010 Mar;12(1):39-47. n = 102.
Dr. Östman has a financial relationship with BIOMET 3i LLC resulting from speaking engagements,
consulting engagements and other retained services.

†

Reference 1 discusses BIOMET 3i PREVAIL Implants with an integrated platform switching design,

which is also incorporated into the 3i T3® Implant.
*0.37mm bone recession not typical of all cases.

For additional product information, including indications, contraindications, warnings, precautions, and potential adverse effects, see the product package insert and the BIOMET 3i Website.
3i T3, Preservation By Design and PREVAIL are registered trademarks and 3i T3 Implant
design, NanoTite and Providing Solutions - One Patient At A Time are trademarks of BIOMET
3i LLC. ©2013 BIOMET 3i LLC.
All trademarks herein are the property of BIOMET 3i LLC unless otherwise indicated. This
material is intended for clinicians only and is NOT intended for patient distribution. This material is not to be redistributed, duplicated, or disclosed without the express written consent of
BIOMET 3i.


CLINICAL

CAD/CAM anterior esthetic implant restorations:
the BellaTek Encode healing abutment and CADBlock ceramics
Dr. Dean Vafiadis delves into the use of a coded healing abutment

Figure 1

Introduction
Digital design software programs for teeth
and implant restorations have evolved
over the past 5 years.1-3 Using CBCT
scans and digital preoperative scans, the
clinician can properly plan the placement
of implant fixtures.4 Various software
programs and intraoral scanners offer
analysis of proper implant position, angle
of implant placement, and depth of tissue

and occlusal clearance.5,6 The utilization
of coded healing abutments (BellaTek®,
Encode®, Biomet 3i) may also add to the

Dean
Vafiadis,
DDS,
prosthodontist,
is Program Director of the Full Mouth
Rehabilitation CE Course at NYUCD, Clinical
Associate Professor of Prosthodontics and
Implant Dentistry, New York University College
of Dentistry; former Coordinator of Prosthodontics and
Implant Dentistry, St. Barnabas Hospital in New York
City, and Founder of New York Smile Institute. He
has published many articles on CAD/CAM, esthetics,
and implant dentistry and is currently on the Clinical
Advisor Board of Journal of Clinical Advanced Implant
Dentistry, World Journal of Dentistry, Dental XP, and
Stemsave.com. He is radio show host of Talk N’ Teeth,
on COSMOS 91.5 FM and has given 500 programs and
educated over 8,000 dentists over the past 18 years in
the U.S. and abroad. He is a member of ACP, ADA, AO,
ICOI, and AACD and in in private practice in New York
City. He can be reached at:
New York Smile Institute
693 Fifth Avenue
New York, NY 10022
212-319-6363
www.NYSI.org

12 Implant practice

Figure 2

precision of design and calibration of all
tissue contacting points of the emerging
abutment.7-10
The proper design of a healing
abutment circumferentially can support
the tissues when necessary or can relieve
the areas of thin tissue or underlying bone.
Each area of the healing abutment contact
surface plays an integral role for the final
tissue position. Although prefabricated
abutments are widely used, CAD/CAM
customized healing abutments can be
designed to support tissue. Instead of using
fixture level impression technique, a coded
healing abutment was used. The intraoral
scanner captured the codes on this healing
abutment. The use of intraoral scanners
to capture the Encode healing abutment
rather than a conventional impression
material provide benefits in accuracy of
models in maximum intercuspation position
(MIP) and model fabrication.11 Unlike
stone casts that may have expansion and
water-sorption properties, digitally printed
models can avoid these potential sources

of error, especially in mounting, indexing,
margination, casting, and most importantly,
occlusion. This article will introduce and
describe a current model for fabrication of
ideal abutments, and fabrication of CAD/
CAM restorations for the anterior esthetic
zone.

Figure 3:

Case presentation anterior central
incisor No.8
Materials used and steps to final
restoration
• CBCT scan of planned surgery,
GALILEOSđ 3D CT Scanner (Sirona)
ã NanoTite Certainđ( Biomet 3i) internal
connection 4.0 mm implant fixture
• Coded abutments (BellaTek Encode,
Biomet 3i)
• Final impression with intraoral digital
acquisition; Lava™ Chairside Oral
Scanner (C.O.S.) [3M ESPE]
• SLR models created
• CAD/CAM Abutment Design (3-Shape
Abutment Designer/BellaTek, Biomet 3i)
• Final abutment; Zirconia, internal
connection (Certain, Biomet 3i)
• Final impression of abutment and teeth
with Cerecđ Blue Cam (Sirona)

ã Restorative material: monolithic leucitereinforced ceramic (Empressđ CAD-HT,
Ivoclar )
ã Laboratory: NY Smile Labs
ã Cement Utilized = RelyX™, (permanent)
[3M ESPE]
• Restoration time = five visits - 3 months
Patient presented with a traumatic
fracture of the upper left central incisor
(Figure 1). The tooth was extracted
atraumatically without incisions to preserve
interproximal tissue. Software was utilized in
conjunction with a CBCT scan to fabricate
Volume 6 Number 5


CLINICAL

Figure 4

a surgical guide. The precise measurement
of this particular central incisor width at
the root section, 3 mm above the CEJ
restoration, was measured at 5.73 mm.
Because the natural tooth was available for
measurement, the root was also measured
after extraction and was measured at
5.97 mm. (Note: The average of these
two measurements would be used as the
final abutment width later in the design
phase.) Considering that the natural tooth

is not always available, the measurement
from the CBCT scan could be used as a
guide in other instances. A 4.0 mm wide
endosseos implant was placed (NanoTite™
Certain, Biomet 3i) [Figure 2]. The site was
sutured and healed with primary closure.
It was determined that the adjacent teeth
would also need restorations in the future.
A bonded provisional was fabricated from
a composite, autopolymerizing provisional
material (Luxatemp®, DMG) and placed for
a 6-month healing period. The provisional
was removed after implant healing,
and the implant fixture was exposed
without flapping the gingival tissues. A
prefabricated abutment was used to
develop and scallop the tissue to conform
to the ideal central incisors cervical shape
(Performance® Post, Biomet 3i). This
was made using highly polished flowable
composite material (LuxaFlow, DMG) with
a screw-retained method for a period of 6

Figure 6

weeks. After the tissue had matured, the
provisional abutment was removed, and
a coded healing abutment was placed
(BellaTek, Encode impression abutment,
Biomet 3i) [Figures 3 and 4]. At this time,

a digital impression of the coded healing
abutment was made with an intraoral
scanner (Lava C.O.S., 3M ESPE) [Figures
5-7].

Figure 7

Figure 5

the transfer of digital information from the
clinical environment to the laboratory in a
matter of minutes.

The digital scan begins with isolation
of the coded abutment, ensuring that it
is more than 2 mm above the gingival
tissues. The tissues must be dry and clean.
A series of scans from the occlusal view
of the abutment are captured. After this
is completed (approximately 2 minutes),
an additional scan of the lower opposing
arch is made (approximately 1 minute). A
third scan of the teeth in MIP is also made
(approximately 1 minute). The software
program merges these three scans onto
a virtual model on the computer screen.
The clinician chooses the tooth area
to be restored, confirms the accuracy
and capture of all the data points, and
approves the scan. The clinician completes

the laboratory prescription form and sends
the file via email to the corresponding
laboratory for model fabrication and final
abutment fabrication.
Many variables such as implant
width and connection, depth of tissue,
abutment material, margin placement,
surface texture, shade, and final restorative
material are all chosen by the clinician.
This ensures that the clinician will achieve
the exact result that was planned for each
patient. The digital scan of the occlusal

Intraoral scanning and design
Fabrication and design of implant
abutments
has
been
previously
published.7-10 Using CAD/CAM software to
design the final abutments has increased
the precision of designs and decreased
laboratory fabrication times. The specific
design programs require information
from the clinician to better understand
each specific tooth emergence for each
site. Using radiographs, tissue biotypes,
and algorithmic equations, the design
technician, in conjunction with the clinician,
can better design the final contours and

emergence that are necessary for ideal
tissue support and long-term tissue
stability. The use of intraoral digital
acquisition units (Table 1) can also help the
fabrication of CAD/CAM restorations that
follow the emergence from the abutment to
the final restoration. Using a coded healing
abutment such as Encode can facilitate

Table 1: Various digital acquisition software

Digital Impression

Digital Impression +
In-Office Milling

CAD/CAM Abutments

Lava/3M ESPE

E4D/D4D Technologies

Encode/Biomet 3i

iTero/Cadent
Trios/3-Shape

Procera/Nobel Biocare
Cerec AC 4.0/Sirona

Atlantis/Astra Tech
Akton System/Straumann

Volume 6 Number 5 Implant practice 13


CLINICAL
relationships in MIP position is more precise
and accurate than stone casts because
they are captured digitally in a static mode,
as opposed to models being mounted with
a bite registration. The files are emailed
to the digital facility (BellaTek Production
center, Biomet 3i) and are then transferred
to 3-D shape software for design.
Design of final abutments
There are four areas of clinical importance
for designing the abutment. Their relative
importance is as follows:
1- Gingival margin position as it relates to
thick or thin biotype of tissue
Depth of tissue around abutment
2-
circumferentially as it relates to the
radiograph of the bone
3- Angle of the emergence as it relates to
algorithmic equation to determine tissue
displacement, especially on the facial
aspect of this patient treatment (Figure 8)
4- Width of the gingival floor as it relates to

the support of all ceramic materials as they
seat on the abutment.12 In this patient, it
was measured at 1.7 mm. Note: The width
of the final abutment will be designated at
5.8 mm based on the original width of the
natural tooth that was extracted (Figures
9-13).
Once the design is approved by
the clinician or the laboratory, the final
abutment is milled from either a titanium or
zirconia material. The abutment is polished
and finished, and returned with the digital
model to the laboratory. The laboratory
delivers the final abutment to the clinician.
The provisional restoration is removed,
and the ideal final abutment is placed into
position. The final abutment is placed and
torqued to proper position based on the
manufacturer’s recommendation (30Ncm)
[Figures 14-16]. The adjacent teeth were
prepared for ceramic crowns due to decay
at the root surfaces. A highly polished
provisional is placed to secure the tissue
position and to allow the interproximal
tissue to grow as much as possible. The
provisional was fabricated with autopolymerizing
composite
provisional
material (LuxaTemp, DMG) [Figures 1719]. The tissues were allowed to heal for
3 weeks. The preparations and abutment

were now ready for the final impression.

Digital scanning of the abutments
and teeth

Figure 8

Figure 9

Figure 11

Figure 14

Figure 17

Figure 10

Figure 12

Figure 15

Figure 13

Figure 16

Figure 18

Intraoral scanning
The provisional is removed, and the teeth
and the implant abutment are cleaned.

14 Implant practice

Volume 6 Number 5



CLINICAL

Figure 19

Figure 21

Light powder is applied to the abutments,
and the access hole is temporarily sealed
with Teflon tape and flowable lightcured composite resin. Using a CAD/
CAM intraoral scanner (Cerec 3D blue/
cam, Sirona), the abutment and teeth
are scanned in the mouth (Figure 20).
Also needed are an occlusal scan of the
sextant, a frontal scan in MIP position,
and the scan of the opposing arch. The
software merges the three scans onto
one design virtual model on the computer
screen. In the preparation window of the
design software, digital scans are captured
of the abutment and teeth. The amount of
digital scans depends on the size of the
restoration and how many adjacent teeth
are involved. The average is seven to eight
scans.

Computer Assisted Design - CAD
Once the digital images have been
approved, the abutment margin and teeth
margins are highlighted and verified for
exact position. This is called margination,
the exact margin that the restoration will
be milled to. In the settings mode, the
parameters for each type of restoration can
16 Implant practice

Figure 20

Figure 22

be adjusted for each clinician’s preference.
Some of these parameters include occlusal
offset, margin thickness, cement spacer,
and restoration thickness. A scan of the
perfectly contoured provisional restorations
is used in “correlation” mode to best mimic
what has been created, in terms of contour,
contacts, and shape.
Each restoration must be designed
separately and then merged together in the
final master digital mode. Additional design
features such as “add” and “smooth” tool
can be used to finalize the shape each
restoration.
Occlusion
The ideal occlusion contact position is

carefully designed with freedom in the
anterior from MIP. This position is critical in
the anterior implant restoration because the
adjacent teeth have an adaptive PDL that is
different than a fixed dental implant. Careful
occlusion analysis needs to be performed
so that initial contact is on natural teeth first.
Using articulating paper with a 20-micron
thickness (AccuFilm® red/black, Parkell)
can show the clinician the variable contact
points of natural teeth compared to the

implant restoration. It seems logical that
the 20-micron articulating paper should be
free of contact on the implant restoration
when the adjacent teeth are in contact
and marking the paper. Other thickness of
articulating paper may be used to further
examine the movement of the anterior
adjacent teeth, in protrusive movement,
before the implant restoration comes into
contact. Interproximal contacts are also
adjusted to desired position, one at a time.
Computer Assisted Milling - CAM
Various CAD block materials have
reportedly been used as final crowns and
veneers.13-14 The restoration is designed
for each tooth position. After the final
design is approved, it is sent to the milling
center for final mill. The designated blocks

chosen for this patient treatment were
Empress CAD blocks LT (Ivoclar/Vivadent).
In the pre-glazed phase after milling, they
are tried intraorally for final occlusion and
interproximal contact points. Selective
grinding with a high speed handpiece
is necessary to get the proper contour
and transmission of light on each tooth.
Shaping, incisal thinning, and polishing
Volume 6 Number 5



CLINICAL
are critical to the natural appearance
of the restorations. After approval of fit
and position, they are placed in the firing
oven for final crystallization and glaze with
the appropriate shade and stain match
for the adjacent teeth. Final radiographs
are taken, and then the restoration is
cemented with final cement. A dual-cured
resin cement (RelyX™ 3M ESPE) was
used for cementation. Final occlusion was
confirmed with digital occlusion analysis
(Tekscan®).

The patient returned for follow-up in 3
and 6 weeks, respectively. The restorations
were checked for gingival health, occlusion

verified, and final photos taken (Figures 2123).

Advantages
of
CAD/CAM
impressions and restorations
• Avoiding conventional steps such as
impression material, strong gag reflex,
pouring, mounting, alginate, bagging,
delivery, pindex, ditching, etc.
• Reduces laboratory costs and lab time
• Saves time for clinician, laboratory, and
patient
• Most accurate interocclusal records
• Margin capture and review more easily
seen than cast ditching
• Fewer remakes
• Saves office costs due to materials,
trays, dental assistant
• Impressive technology for patients
• Promotes better preparations
• Digital files can be transferred with backup and no loss of cases
• Digitally trained designers

Disadvantages
• Cost of scanners

Figure 23

Figure 24

• Learning curve of 2 to 3 months
• Complete isolation, which means no
tissues and no fluids in the scanning field
• Bulky equipment in the operatory
• Continuing education

translucency in addition to fit and marginal
integrity. Computerized and CAD/CAM
prosthodontic care of our patients can be
more efficient, more predictable, and save
chair time for our patients.

Conclusions

Acknowledgements

The use of in-office CAD/CAM techniques
has been highlighted to fabricate anterior
implant crowns.
Utilizing the coded
healing abutments can save time and
increase efficiency with the digital designs
of final abutments. The clinician can use
clinical knowledge to help designers make
ideal final abutments. Monolithic leucitereinforced and feldspathic ceramic blocks
can be utilized to fabricate life-like color and

The author would like to thank NY Smile
labs and Carlos Carranza, MDT, New

York City, and Roe Dental Laboratory,
Cleveland, Ohio for their dedication to
digital technologies, the Bellatek production
team at Biomet 3i for their digital designs
and endless work ethic, Dr. Jim Jacobs,
Periodontist, New York City, and John Kim,
dental digital officer for their efforts on this
patient’s successful treatment. IP

References
1. Binon PP. Evaluation of machining accuracy
and consistency of selected implants, standard
abutments and laboratory analogs. Int J Prosthodont.
1995;8(2):162-178.
2. Finger IM, Castellon P, Block M, Elian N.
The evolution of external and internal implant/
abutment connections. Pract Proced Aesthet Dent.
2003;15(8):625-632, 634.
3. Priest G. Virtual-designed and computer-milled
implant abutments. J Oral Maxillofac Surg. 2005;63(9)
(suppl 2):22-32.
4. Patel N. Integrating three-dimensional digital
technologies for comprehensive implant dentistry. J Am
Dent Assoc. 2010;141(suppl 2):20S-24S.
5. Birnbaum NS, Aaronson HB. Dental impressions
using 3D digital scanners: virtual becomes reality.
Compend Contin Educ Dent. 2008;29(8):494, 496,
498-505.

18 Implant practice

6. Christensen GJ. Will digital impressions eliminate the
current problems with conventional impressions? J Am
Dent Assoc. 2008;139(6):761-763.
7. Drago CJ. Two new clinical/laboratory protocols
for CAD/CAM implant restorations. J Am Dent Assoc.
2006;137(6):794-800.
8. Grossman Y, Pasciuta M, Finger IM. A novel
technique using a coded healing abutment for the
fabrication of a CAD/CAM titanium abutment for
an implant-supported restoration. J Prosthet Dent.
2006;95(3):258-261.
9. Vafiadis DC. Computer-generated abutments using a
coded healing abutment: a two-year preliminary report.
Pract Proced Aesthet Dent. 2007;19(7):443-448.
10. Vafiadis DC. Full arch restorations using
computerized abutments. Implant Dent Today.
2011;June:30-35.

11. Ramsey CD, Ritter RG. Utilization of digital
technologies for fabrication of definitive implantsupported restorations. J Esthet Rest Dent.
2012;24(5):299-308.
12. Akbar JH, Petrie CS, Walker MP, Williams K, Eick
JD. Marginal adaptation of Cerec 3 CAD/CAM crowns
using two different finish line preparation designs. J
Prosthodont. 2006;15(3):155-163.
13. Guess PC, Zavanelli RA, Silva NR, Bonfante EA,
Coelho PG, Thompson VP. Monolithic CAD/CAM lithium
disilicate versus veneered Y-TZP crowns: comparison
of failure modes and reliability after fatigue. Int J

Prosthodont. 2010;23(5):434–442.
14. Vafiadis D, Goldstein G. Single visit fabrication of a
porcelain laminate veneer with CAD/CAM technology: a
clinical report. J Prosthet Dent. 2011;106(2):71-73.

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CLINICAL

Restoring the edentulous maxilla
Dr. Ross Cutts discusses a cost effective way to restore the edentulous upper arch
Case study
This case demonstrates the successful
use of Straumann Locator® abutments in
the atrophic anterior maxilla.

W

hen restoring the edentulous maxilla,
there are many different methods
dictated by various implant systems. Each
differs in cost and the number of implants
required to support the restoration – and
more importantly, in how well-supported
they are by sufficient levels of clinical
research that demonstrate long-term
success rates. Therefore, it can be difficult
selecting the most suitable system and
methods for your patients.

The Straumann Locator abutment
was launched in its current form in
2009, following years of research and
development, and many clinicians haven’t
looked back since.

The ease of use – both in the practice
and in the laboratory – make for a very
simple yet successful and safe method
for fixating an upper overdenture with a
cement-retained restoration (Figure 1).

Figure 1: Locator abutment

Figure 2: Failing natural dentition

Figure 3: Restored natural dentition

Figure 4: Lack of soft tissue support

Figure 5: Soft tissue replaced with pink acrylic

Figure 6: Previously extracted full arch, showing
emphasized bone loss with a thin flabby ridge

especially for those who are used to a
loose, removable prosthesis, or who have
a severe gag reflex. These types of patients
will often want to avoid a removable
denture-type restoration.

Loose dentures are often caused, or
a result of bony resorption of the denturebearing area.

Most bone resorption occurs 1 to 3
years post-extraction, but it never really
stops – it merely decreases in rate. It
is this lack of bone structure that often
means fixed prostheses are unavailable to
the patient without the need for extensive
bone-grafting procedures.

Patients with a hopeless residual
dentition are also more likely to favor a fixed
prosthesis for rehabilitation (Figures 2 and
3).

However, it is important that we have
an open and honest discussion with our
patients regarding the limitations of a fixed
prosthesis. As these restorations are far
more demanding in terms of maintenance,
patients with a failed natural dentition are
often not appropriate, because if fixed
prostheses are not properly maintained
and cared for, this can lead to problems 5
to 10 years post-rehabilitation.

Patient’s perspective
When deciding upon the design of a full arch

maxillary prosthesis, there are often various
options available. However, any prosthesis
must be comfortable, retentive, functional,
and esthetic with good appearance of both
hard and soft tissues. The patient’s speech
and taste must not be impaired and, at all
times, we must consider how all of these
factors can influence his/her self-esteem.
From the patient’s perspective, a
fixed restoration is sometimes preferred,

Dr. Ross Cutts is the principal dentist at Cirencester
Dental Practice, Gloucestershire, England. Having
graduated from Guy’s Hospital, Dr. Cutts is a general
dentist with special interests in advanced restorative
procedures and dental implants. He has been awarded
the highly regarded Diploma in Implant Dentistry
from the Royal College of Surgeons, London, and
is a committed member of the International Team for
Implantology (ITI), where he is a study club director and
clinical mentor. He regularly holds implant courses at
his Cirencester practice, and lectures nationwide on a
variety of topics at different levels. He is also a member
of the Association of Dental Implantology, the British
Academy of Cosmetic Dentistry, and the Royal College
of Surgeons.

20 Implant practice

Volume 6 Number 5

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CLINICAL

Figure 7: Recently extracted teeth next to overdenture
locators

Figure 8: Edentulous maxilla showing marked resorption
and knife-edge nature due to long-term tooth loss

Figure 9: Edentulous maxilla with opposing teeth following
recent extraction

Figures 10 and 11: The atrophic maxilla with evidence of pronounced incisive papilla, showing extensive maxillary atrophy and opposing lower arch model

Figures 12 and 13: Surgical implant placement in the narrow ridge with simultaneous-guided bone regeneration to increase ridge width

Careful planning
Often in cases of moderate maxillary
atrophy, there is a large deficiency in hard
and soft tissue volume. This means that a
fixed prosthesis can have long proclined
teeth, which is not necessarily esthetically
or phonetically successful. Careful planning
of the final appearance of the prosthesis is
therefore crucial.
22 Implant practice


Often this discrepancy can be rectified
with an overdenture-type restoration,

allowing the appropriate choice of tooth
size. In addition, the use of pink acrylic to
replicate the support for lips and missing
keratinized tissue will create highly esthetic
results (Figures 4 and 5).
It’s worth noting that if teeth have
been recently extracted to become a full

arch, the fixed solution is likely to create
more esthetic results. Similarly, the longer
the teeth have been missing, the greater
the chance of substantial hard and soft
tissue loss (Figures 6 and 7).

Successful full arch rehabilitation
As it has been well documented that
an edentulous maxilla opposed by a
Volume 6 Number 5


CLINICAL
BONE GRAFTING SOLUTIONS

Figure 14: Exposure of the implant fixtures and placement
of Straumann Locator abutments

Figure 15: The pick-up impression copings attached to
the Straumann Locator abutments

complete natural lower dentition causes

severe maxillary atrophy, it’s important
that we evaluate interarch relationships in
the planning stage, and discuss this with
patients, stressing that early intervention of
treatment will greatly reduce the need for
complicated grafting procedures (Figures
8 and 9).
However, we do know that there is
scientific evidence, which clearly shows
that either removable or fixed implantsupported rehabilitation of an edentulous
jaw can significantly improve a patient’s
quality of life (Wismeijer, et al., 1992; 1995;
1997). We understand that in the maxilla
we have less favorable bone quality and
quantity than in the mandible, so our
options are reduced. Weng, et al., (2007),
clearly showed that placing only two
implants in the anterior maxilla is a risky
procedure with poor long-term survival and
success rates.
In light of this research, we now
know that placing four maxillary implants
is the minimum for a successful full arch
rehabilitation. If we use locator abutments
such as Straumann Locator abutments
– a relatively more cost-effective and
straightforward method for retaining an

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©2012 Sunstar Americas, Inc. GDR12036 80812 v1

Volume 6 Number 5 Implant practice 23