Anterior Esthetics with Hybrid Abutments

In this particular case, the patient presented with three implants in the anterior region—two 4.5 mm diameter implants in teeth Nos. 6 and 12, and one 3.0 mm diameter implant in tooth No. 9.

After tissue and occlusal analysis, the dental team decided to use zirconia abutments on titanium bases (hybrid abutments). Since a titanium base was not offered for the 3.0 mm implant, it was necessary to move forward with a custom-made full zirconia abutment, which was designed in-house. The milling of the restoration was then outsourced.

After receiving the zirconia abutment for tooth No. 9, the upper and lower arches were scanned using the Ceramill Map400 Scanner (Amann Girrbach, www.AmannGirrbachAmerica.com) in proper bite relation with scan bodies for the 4.5 mm abutments.

From there, the author’s team aligned the scan bodies with the scan body library (Figure 1) and completed the design using the Ceramill Mind software (Amann Girrbach) (Figure 2). The author began this process by setting up the abutment margin and designing the emergence profile. The software allows the user to position the margin exactly at the right spot to get a hygienic and esthetic shape. Next, the author adjusted the abutment body to the proper size and shape, using the final crown/bridge design to get the perfect position and angle for the abutment (Figure 3).

Using Exocad-based software provides the dental team with an advantage in that after designing the abutments, the restoration can then be immediately designed on top of them. This significantly reduces production time because the abutment and restoration can be milled simultaneously.

In this case, because the abutment design was done previously, no scan was necessary for designing the bridge. The author’s team set up margins, selected and placed anatomical shapes from the library, and designed connectors, which are fully customizable by position, shape, and size. Using photos of the patient and study model scans, the dental team worked to design a look that was very close to the specific desires of the patient and clinician.

The bridge design was milled out of PMMA (Figure 4) and the abutments out of zirconia (Figure 5). For the abutment zirconia, the dental team chose Ceramill Zi from Amann Girrbach for its opacity, which helps mask the titanium base underneath.

The abutments were then sintered and bonded on titanium bases to create a try-in from which the clinician could verify the esthetics of the bridge with regard to length, shape, and size. This try-in was also used as an insertion tool for the abutments after opening the screw access holes in the bridge.

Once the esthetics and fit were verified, the author used the Ceramill Mind (Amann Girrbach) software to adjust the bridge design to meet the clinician’s needs, and reduced the facial to make room for porcelain.

The final zirconia bridge was milled using the Ceramill Motion 2 5-axis mill (Amann Girrbach) from the very translucent and highly esthetic Ceramill Zolid, and then colored with Ceramill Liquids (Figure 6) and sintered it overnight in a Ceramill Therm furnace (Amann Girrbach)(Figure 7 through figure 9). The next day, the author applied porcelain and created pink papillas to give the bridge a more natural look (Figure 10 and Figure 11).

When possible, the author tends to restore esthetic implant cases with hybrid abutments because the titanium base offers high strength at the implant connection, while the zirconia supports the esthetic zone and offers a vast range of shades. For these reasons, the author selected hybrid abutments for teeth Nos. 6 and 12. However, for reasons related to factors such as angulation, tissue thickness, and implant size, there are situations where hybrid abutments cannot be used. In this case, the author chose a full zirconia abutment for tooth No. 9 because the tissue thickness and height were not ideal for a titanium abutment, and a titanium base was not offered for the respective implant size.

In the end, the team and the patient were very happy about the result and the straightforward workflow.

Alexander Wunsche,CDT is the production manager at Zahntechnique Dental Laboratory in Miami, FL.

Disclaimer: The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dental Technology.

For more information, contact:
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