Immediate Smile bridge: CAD/CAM restorations for immediate loading

Clearly the ability to engage a patient's understanding of the challenges associated with their treatment is contemporary patient care in the 4th dimension.

Fig. 1: Pre-operative view: maxillary denture and mandibular metallo-ceramic fixed splint and bridge. The bridge has failed due to caries and root fractures.

Fig. 2: Occlusal view of the bridge containing two attachments for support of a removable denture.

Fig. 3: Biomet 3i tapered Osseotite implants planned with SimPlant Planner software viewed three-dimensionally.

Fig. 4: Virtual Tooth set-up planned with SimPlant Planner software using the existing prosthesis to guide and align future implant-supported interim prosthesis relative to planned implant placement.

Fig. 5: CAD/CAM-milled Immediate Smile bridge. The prosthetic space to accommodate the temporary cylinders has been provided during the online ordering process.

Fig. 6: The bridge has small injection holes at the vestibular side which are used to inject a composite cement. With this technique, the temporary cylinders are secured and a passive fit is achieved.

Fig. 7: Removal of the metallo-ceramic bridge.

Fig. 8: A SurgiGuide bone reduction guide makes it possible to horizontally section the teeth and reduce the bone simultaneously using Piezo-electric instrumentation. This simplified root removal without traumatizing the bone.

Fig. 9: The Biomet 3i Navigator SAFE SurgiGuide is secured on the reduced bone using three fixation screws.

Figs. 10,11: Initial pilot drilling using the Navigator surgical kit. The SAFE SurgiGuide controls position, angulation and depth of the drill.

Fig. 12: Implant placement through the SurgiGuide using Biomet 3i Navigator implant holders to allow for accurate implant installation with depth control.

Fig. 13: Post-operative view after removing the SurgiGuide. All implants are placed correctly as planned in SimPlant.

Fig. 14: Placement of low profile tapered abutments for a multiple-unit screw-retained interim provisional restoration.

Fig. 15: The parallelled temporary cylinders are placed directly in the mouth, the non-parallelled cylinders are placed inside the bridge. This technique allows for compensation of the different insertion axis.

Fig. 16: The non-parallelled cylinders are tightened onto the abutments after the restoration is seated.

Fig. 17: The patient occlusion was adjusted to a repeatable and relaxed condylar hinge position. The cylinders are not yet secured, allowing the bridge to align itself into the correct occlusion. With this procedure, substantial reduction in time-consuming occlusal adjustments reduces the length of treatment time.

Fig. 18: The temporary cylinders are secured onto the bridge by injecting SmartCem2 composite luting cement.

Figs. 19,20: When all cylinders have been secured, the bridge is removed for further finishing outside the patient’s mouth.

Fig. 21: The abutment replicas are screwed onto the temporary cylinders and the remaining cervical gap is filled with SmartCem2. This ensures a smooth surface for optimal healing of the soft tissue.

Figs. 22, 23: Frontal and occlusal view of the Immediate Smile bridge.

Fig. 24: Frontal view of the finished Immediate Smile bridge in maximal occlusion. Tooth 21 and 22 of the upper denture are slightly adapted to create an ideal, esthetic incisal plane.