CATEGORY 56 AUSTRALASIAN DENTIST where the substructure for the provisional restoration was designed taking into account the critical contour areas. For this purpose, the preoperatively produced models were used as a support. The substructure was designed and milled using the CAD/ CAM technique. u This aesthetic substructure was shaped to restore, and maintain the gingival margin in its original position. The substructure was milled on a 5-axis milling and grinding machine (inLab MC X5, Dentsply Sirona) using a nanohybrid composite disc (Grandio disc, A1 LT, VOCO). It was then cemented on the above mentioned Neodent’s Smart abutment thanks to a dual-curing universal adhesive luting system (Bifix Hybrid Abutment, VOCO). This resulted in a hybrid abutment (Fig. 10). u To guarantee adequate space for all layers, the substructure presented a small cutback (Fig. 10, Fig. 11) that was designed in the CAD planning. This hybrid abutment was tested on the implant to verify correct position, passive adaptation to the tissues and correct position of the margin. u After fixation in its final position, a direct composite veneer (Admira Fusion, VOCO) was layered onto the CAD/CAM substructure under a rubber dam (Fig. 12-21). The absolute isolation of the rubber dam also prevented any unwanted contact of the peri-implant soft tissue with adhesive or composite material. The layering was first carried out at the cervical area (Fig. 15 and 16). Once completed, the hybrid abutment was unscrewed for polishing so to avoid any injury or contamination of the soft tissue. Finally, the abutment was screwed down again with a torque of 25 Ncm (Fig. 17). u The layering of the middle and incisal thirds was carried out using a sectioned silicone key, and the composites for the creation of the transparent halo effect on the incisal edge were accurately placed (Fig. 18 to 20). u The individual colour characterisation was made using FinalTouch (VOCO) (Fig. 21). u The postoperative tomography confirmed the correct positioning and adjustment of implant components (Fig. 22). Here you can see that the use of a concave abutment created space for graft materials and ensured long-term tissue thickness. Intraoral images showed excellent (micro-) texture of the composite restoration and optimal adaptation to soft tissue (Fig. 23). The final aesthetic result is highly satisfactory, with the composite imitating the natural tooth excellently (Fig. 24). Results In the present case, the patient was highly satisfied with the aesthetic result of the treatment. A direct composite veneer was layered to restore tooth 21, achieving a Figs. 12 to 14 Preparation for the layering of composite veneer under absolute isolation with a rubber dam. Figs. 15 and 16 Layering of composite veneer. After a shade analysis, layering begins mainly in the cervical sector. Figs. 18 and 20 The layering of the middle and incisal thirds is carried out using a sectioned silicone key, and the composites for the creation of the transparent halo effect on the incisal edge is accurately placed. Figs. 12 to 14 Preparation for the layering of composite veneer under absolute isolation with a rubber dam. Fig. 17 After layering the cervical area, the hybrid abutment is unscrewed for an extraoral polishing. Here you see the re-screwing with a torque of 25 Ncm. Figs. 18 and 20 The layering of the middle and incisal thirds is carried out using a sectioned silicone key, and the composites for the creation of the transparent halo effect on the incisal edge is accurately placed. Figs. 15 and 16 Layering of composite veneer. After a shade analysis, layering begins mainly in the cervical sector. Figs. 18 and 20 The layering of the middle and incisal thirds is carried out using a sectioned silicone key, and the composites for the creation of the transparent halo effect on the incisal edge is accurately placed. Fig. 21 The individual colour characterisation is finally made using FinalTouch (VOCO). CLINICAL
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