Fig. 1: Complete teeth and gum design in exocad.
Fig. 2: Bar on implants with passive connection.
Fig. 6: The secondary zirconia structure was milled from a 25 mm Initial Zirconia Disk Multilayer Elite.
A misfit of the suprastructure can have negative effects, such as detrimental stresses on the bone- titanium junction or prosthetic problems, such as screw loosening. The dentist verified the seating of the aluminium bar, cut and splinted it in the new position for a perfect passive fit (Figure 3) and sent it back to the lab. Then, the analogues were placed and the new position was fixed using a silicone base former and FujiRock Polar White gypsum. This was scanned with scanbodies and overlap meshes in exocad to have the new position of the analogues located in the three-dimensional space of the original design.
A prototype based on the digital design and with the optimised implant positions was then 3D-printed (Figure 4). This step served to verify the gum pressure, function, and aesthetics intraorally. After verification of the passive structure and intraoral mock-up, the primary and secondary structure were designed in Blender4Dental (Blender). The primary structure consists of a titanium bar (Figure 5) that needs to be screwed onto the prosthetic abutments and is then completed with a secondary zirconia structure. This secondary structure was milled from Initial Zirconia Disk Multilayer Elite from GC, Shade A2 (Figure 6).
Fig. 7: Zirconia framework after removal from the disk and manual cut-back.
Fig. 8: Initial Zirconia Disk Multilayer Elite framework after sintering (Shade A2).
In the middle area of the central and lateral incisors, a light refracting zone between the cervical area and the incisal area was created with a mixture of L-V and L-1. This effect adds to the natural appearance. In the incisal area, a light absorption zone was created at the free edge with L-5 and a mixture of L-6 and L-3.
The mamelons were created with a mixture of L-V, L-1, L-B and SPS-4. Finally, a non-fluorescent L-N base was used for the gingiva, and different gum shades were added to create naturalness.Figs. 9-10: Application of Initial IQ Lustre Pastes ONE with Initial Spectrum Stains (GC).
Fig. 11: Initial IQ Lustre Pastes ONE with Initial Spectrum Stains: result after firing.
Fig. 12: Application of different masses of Initial Zr-FS: EOP-2, EOP-3, E-58, CT-22, FD-92, Dentin A2, CL-F; GM-24, GM-34, GM-36 and GU.
The free gingiva was coloured with G-23+ LP-M4 and G-24, while G-35 was used for the attached gingiva. The alveolar mucosa was coloured last with G-36 (Figures 9-10).
After firing, we already see the beautiful, natural colour and gloss appearing (Figure 11). Further characterisation was done with Initial Zr-FS (Figure 12). These beautiful feldspar-based masses add depth and vitality to the structure. Enamel Opal shades EOP-2 and EOP-3 and E58 were used to mimic the enamel.
Cervical translucent shade CT-22, Fluo Dentin FD-92, Dentin DA2, CL-F were used for the teeth. Gum shades GM-24, GM-34 and GM-36 were combined with gum universal (GU) to finish the gingiva.
Figs. 13-14: Result after glazing.
Fig. 15: The bluish 3D-effect on the incisal edge adds to the vividness of the teeth.
A high-end prosthesis, comprising a high-precision titanium bar and zirconia stands out as the premium choice for a full-arch prosthesis. It is resistant to staining and its smooth, polished surface is less likely to attract bacteria, resulting in easy maintenance and optimal hygiene. (Figures 13-14)
TIP: the blue effect on the edges comes from the combination of the internal characterisation and putting EOP-3 in the same zone, creating that three-dimensional area (Figure 15).
Initial offers a complete system to achieve the highest quality in the most efficient way. The most notable factors are: stability, reproducibility, time and aesthetics.
01. Stability: The Initial materials act reliable and predictable; combined with a good protocol, this gives great control over your work.
02. Reproducibility: That same protocol and materials give reproducible results, minimizing possible errors.
03. Time: Workflows that can be customised to fit the need of each work enable to be more efficient and productive.
04. Aesthetics: Due to the right protocol, the vibrant shades and the consistency in results, a very aesthetic and natural-looking outcome can be achieved, time after time.
CONCLUSION
Considering all these advantages, it stands out as an exceptional choice for delivering durable and satisfying dental solutions (Figures 16-18). By prioritising quality and precision, we can ensure our work leaves a lasting impact on both patients and practitioners alike.
