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Every Case is Unique by Dr. Marco Bartolini and Gianfranco Bartolini

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Biocompatibility significantly contributes to the long-term clinical success of implant restorations and an efficient fabrication procedure enhances the economic success of the treatment team.

Since the introduction of implantology in dental medicine, many changes have taken place in this field. As a result, osseointegration is now considered a matter of course and the restoration of dentitions with implants has become an established procedure throughout the world. Due to ongoing research and development in this field, this treatment modality has become increasingly popular. Furthermore, the number of companies that manufacture dental implants and the corresponding denture components has risen commensurate to the speed at which the developments have been made. However, the large number of commercially available systems has not helped to improve the aesthetic and functional results. Many operators are finding themselves overwhelmed by the confusing variety of products and have difficulties choosing the most suitable components.

Implant-supported crowns are not all the same. Each patient has individual needs that have to be taken into consideration. Today’s dental teams have numerous treatment options at their disposal. Generally, abutments are divided into two categories: ready-made or customized (titanium, zirconium oxide, etc.). Ready-made abutments are machined components with standardized shapes and dimensions; custom-made abutments are specially created to fit the individual patient.

Custom Abutments

Nowadays, customized abutments are considered to be an efficient solution for placing a restoration on an implant. Moreover, this type of abutment offers more control over the aesthetic and functional aspects of the restoration than readymade abutments.

Benefits of Customized Abutments

  • Aesthetic results: imitation of the natural contour and emergence profile of the tooth
  • Excellent control of the fit: positioning of the subgingival margin
  • Thorough and precise removal of cement excess in the luting of crowns

The new IPS e.max Press Hybrid Abutment made of lithium disilicate (LS2) together with a titanium base (Ti base) offers an optimum solution for fabricating functional implant-supported restorations (strength of 400MPa) and satisfying discerning aesthetic demands. Due to the combination of the titanium base and the lithium disilicate glass-ceramic, implant-supported restorations can be tailored to the needs of the individual patient. The long-lasting bond between the two components, that is, the Ti base and LS2, is generated with the self-curing luting composite Multilink Implant, which can also be light-cured if desired.

The following case study shows how efficiently an anterior dental implant is provided with an individually created abutment (press technique) and an aesthetic crown, which was also produced with the press technique.

Case Study

A 42-year-old patient consulted the practice because of a root fracture. Tooth 11 had become discolored due to this injury (Figs. 1 and 2). After a thorough diagnosis revealed that the tooth could not be preserved, a new restoration was planned. The tooth was extracted (Fig. 3) and a conical NanoTite Certain implant (diameter 4, 1, Biomet 3i) was inserted. During the healing period of about 90 days, the lab-fabricated provisional restoration was placed (Fig. 4). The provisional enabled the soft tissue to be conditioned and optimally prepared for the permanent restoration. After the healing phase, the implant was exposed and the provisional fabricated in the laboratory was placed. The provisional was adjusted to the gingival situation in order to stabilize the peri-implant soft tissue. Next, the precision impressions as well as all the other required information was conveyed to the dental lab technician. The models were fabricated in the customary way in the dental laboratory (Figs. 5a-c). Precision is also called for in this process. The models were subsequently placed in the articulator in accordance with the maxillomandibular relationship record.



A commercial titanium base, which complies with the IPS e.max Press Abutment Solutions instructions for use, was selected for the fabrication of the customized abutment. According to these directions, only bases made of Ti or Ti alloys with a shoulder margin width of at least 0.6mm and a height of at least 4.0mm should be used. In the case presented, we decided to use a titanium base coated with titanium nitride. This material has a gold-like color and is very hard.

Since the ideal crown shape was already determined during the wax-up stage, the subsequent working steps were carried out efficiently with the silicone matrix, which was based on the waxup. The abutment was built up in wax and its shape and size were checked with the matrix. Then, the built-up abutment was reproduced with IPS e.max Press (lithium disilicate glass-ceramic) in the suitable tooth color (LT A1). After the restoration had been pressed, it was divested (Fig. 6) and fitted on the titanium base. A spray was used to localize any occlusal interference. After a few adjustments had been made, the abutment fit precisely on the titanium base and was ready for polishing. Next, both components – the abutment and the Ti base – were prepared for cementation with the self-curing luting composite Multilink Implant (Fig. 7). The instructions of the manufacturer were closely observed in the process. The bonding surfaces were carefully cleaned. The pressed component (lithium disilicate) was etched with 5% hydrofluoric acid and rinsed with water. Then, the primer (Monobond Plus) was applied to both the dried parts. Subsequently, the restoration was cemented with the luting composite (Fig. 8). After the cement residue had been removed, the fit of the abutment and the gingival emergence profile were checked in the mouth of the patient (Fig. 9). Since all the parameters were in order, the work in the laboratory could proceed.

The silicone matrix of the wax-up was also used in the fabrication of the permanent crown. The crown or coping was correspondingly built up and then reproduced with IPS e.max Press lithium disilicate glass-ceramic. After the coping had been divested and its fit checked, the customized ceramic veneer was applied using the IPS e.max Ceram layering ceramic. A sophisticated layering scheme was used to produce the natural-looking result. Special attention was given to finishing the surface structure of the restoration (Figs. 10a-d). The ceramic crown was sent to the dental practice together with the hybrid abutment (Fig. 11). The dentist in charge of the case re-checked the fit of the abutment and cemented it to the crown. For this purpose, the self-curing luting composite Multilink Implant was used. Finally, the cement residue was meticulously removed and an X-ray was taken to check the situation (Figs. 12 and 13).

Conclusion

The customized hybrid abutment made of IPS e.max Press offers an excellent solution for highly aesthetic requirements and ensures outstanding integration, high precision and the possibility of creating a customized emergence profile. Since this procedure is not time-consuming or expensive, we consider it to be our treatment of choice. In the end, the patient "only" sees the crown that looks as if it has emerged like a natural tooth from the gingival tissue. The dental team, however, is fully aware of the importance of the "underlying" components and the responsibility of choosing them properly. This knowledge enables them to achieve natural-looking results (Figs. 14 and 15).

  Author Bios
Dr. Marco Bartolini can be reached at: drmarcobartolini@tin.it.

Gianfranco Bartolini can be reached at: gmg-dental@libero.it.

Both authors work in Riccione, Italy.
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September 2025
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