Access to Straumann CARES® Customized Abutments through

Straumann® CARES® Scan & Shape Online
Access to Straumann CARES®
Customized Abutments through
Straumann CARES® Scan & Shape Service
This 65-year-old patient presented with poor prognosis of her maxillary dentition due to periodontal disease and gross carious lesions. The mandibular
anterior teeth (#23 - 26) as well as tooth # 18 were deemed unrestorable. Full
mouth debridement, scaling and root-planing procedures in combination with
medication (Chlorhexidine Gluconate 0.12% rinses BID and Doxycycline Hyclate 20mg BID) were prescribed and home care instruction was provided. Her
periodontal disease was stabilized prior to the start of implant treatment. She
was otherwise physically healthy and referred to the oral and maxillofacial
surgeon for evaluation. A Cone Beam CT scan was taken with a bite appliance
in situ. An intra-oral digital scan (Align iTero®, USA) was also obtained.
Ethan A. Pansick, DDS, MS, FACD,
FICD
Private Practice in Prosthodontics in
Delray Beach, Florida. Fellow of the
American College of Dentists and
the International College of Dentists.
Speaker of the House for the Florida
The patient was then scheduled for extraction of the remaining maxillary
teeth as well as # 18 and # 23 - 26 with concurrent placement of Straumann®
bone level implants.
The guided surgery was planned using coDiagnostiX™ by Dental Wings
software, with input from the oral surgeon and the prosthodontist, to avoid
sinus lift procedures while still providing the patient with ideal function and
esthetics. The data was also used by the dental lab to fabricate acrylic provisional restorations in conjunction with tooth-borne surgical guides.
Dental Association. Delegate to the
American Dental Association. Adjunct Faculty at Nova Southeastern
University College of Dental Medicine,
Prosthodontics Section, Ft. Lauderdale, Florida. National podium speaker
and continuing education lecturer on
implant and restorative dentistry, interdisciplinary treatment planning,
and digital dentistry.
Fig. 1
Fig. 2
Fig. 5
Fig. 6
drpansick@gmail.com
The mandibular teeth were prepared for conventional crown and bridge restorations one day prior to the planned surgical procedures. Cemented acrylic
provisional restorations were placed on teeth # 18-22 and 27-31.
Straumann SLActive RC Bone Level implants were placed in positions 4, 6, 8,
9, 11, and 13 and Straumann® Roxolid® SLActive® NC Bone Level implants were
placed in positions 23 and 26, through a surgical guide.
Straumann stock cementable abutments with various gingival heights were
selected for each implant to allow the prosthetic interface to be at the level of
the gingiva in order to facilitate removal of the provisional cement. The abutments were then finger tightened and plastic burn-out copings were placed
over them.
The patient returned to the prosthodontist’s office immediately after being
discharged from the oral surgeon’s office. The height of the plastic burnout
copings were adjusted as necessary in the laboratory to gain adequate space
for the provisional restorations to seat passively. Retentive grooves were then
placed in the copings and they were then sequentially luted to the provisional
restorations using polymethyl methacrylate acrylic resin.
Ralph C. Attanasi, Jr, DDS, MS, FACD,
FICD
Private Practice in Prosthodontics in
Delray Beach, Florida. Fellow of the
American College of Dentists and the
International College of Dentists, and
Member of the Pierre Fauchard Academy. President-elect of the Florida Dental Association. Board Member of the
Florida Dental Association Foundation. Delegate to the American Dental
Association. Past President, Atlantic
Coast District Dental Association. National speaker and lecturer on implant
dentistry industry trends, interdisciplinary treatment planning
Fig. 3
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Fig. 7
Fig. 8
drattanasi@gmail.com
The occlusion on the provisional restorations was adjusted to provide balanced occlusal contacts in centric
relation and group function in excursive movements.
The provisional restorations were then polished and
cemented. Special care was exercised to ensure that excess cement was not inadvertently left at the abutmentprosthetic interface. The patient was advised to follow
a soft diet protocol and was seen periodically throughout the 90 day healing interval by the oral surgeon and
prosthodontist, with periodontal maintenance procedures performed immediately prior to the commencement of definitive restorative procedures.
The provisional restorations and stock abutments were
removed in order to obtain implant-level impressions.
Jaw relations were then registered and master casts were
fabricated with removable soft tissue masks surrounding
the implant analogs.
At the patient’s next visit, screw retained composite resin
templates of the proposed restorations were attached to
the implants. The occlusal relationship, drape of the lips
and overall esthetic appearance of the proposed restorations were evaluated.
The prosthodontist used the Straumann CARES Scan &
Shape website interface to design the case and to communicate his design preferences to the CARES design
team. The web interface guides the user through a series
of questions and drop-down menus to obtain any abutment design preferences.
The design options allow for customization of the abutment finish line relative to the oral soft tissue that
surrounds the implant, the emergence profile of the
abutment being designed as well as the material that the
abutment will be made of (titanium, zirconium dioxide
or titanium-alloy). In addition, the abutments can be
designed to be parallel to one another allowing for placement of a fixed prosthesis.
In this case, the composite resin templates of the proposed final restoration were sent to the CARES design
team. The templates were scanned and the abutments
were designed to fit into the confines and contours of the
proposed restorations. The software designs the abutments to provide adequate space for restorative materials
and prosthesis strength.
The proposed designs for the CARES® Customized Abutments
were e-mailed to the prosthodontist for evaluation. The
images were reviewed and minor modifications were communicated to the CARES® Scan & Shape designer who carried
out the changes as necessary. New images of the modified
abutments were then returned to the prosthodontist for final
approval prior to milling the definitive abutments.
The dental laboratory (Stewo Dental Laboratory, Delray
Beach, FL) received the CARES® Abutments and fabricated
high noble gold alloy frameworks for the implants and
single unit crowns for the remaining mandibular teeth.
The metal frameworks were subsequently tried in and
radiographed to insure proper marginal fit and passivity of
fit. Porcelain was added to the metal frameworks and the
completed prostheses were placed in the patient’s mouth for
a try-in and to verify the occlusion prior to final placement.
At the delivery appointment, CARES® Abutments were
inserted and torqued to 30Ncm using a torque controller.
The screw access channels were closed and the porcelain
fused to metal bridgework and crowns were cemented
The patient returned to the prosthodontist’s office 24
hours post-delivery for a final occlusal adjustment. The
patient was delighted with the esthetic and functional
results of her treatment. Impressions were then made for
a maxillary occlusal splint.
Why we chose to use CARES® Abutments?
There are numerous abutment choices available to restore Straumann Bone Level implants. We
elected to place CARES® Abutments rather than stock abutments for several reasons.
Residual cement inadvertently left at the prosthetic interface has become a commonplace implant
complication that leads to soft tissue inflammation and eventual bone loss. By utilizing CARES®
Abutments, we can control the position of the prosthetic interface relative to the position of the
soft tissue, therefore allowing us ideal access to cement at the prosthetic interface.
Since CARES® Abutments are individually designed for each unique implant location in the patient’s mouth, they develop an ideal emergence profile and provide better prosthetic support than
stock abutments. This is clearly illustrated when we compare the contours of the stock abutment
in position 9 to the CARES® Abutment in position 8. (see photo)
The ordering of CARES® Abutments is accomplished using an intuitive online ordering system
and sending the case to CARES® Scan & Shape. Any dental laboratory can access Scan & Shape
to provide Straumann customized prosthetics. Alternatively, a dental lab that has a CARES® CS2
scanner or CARES App connectivity via Dental Wings, 3M or 3Shape can perform this part of the
process in-lab.