Use of CAD/CAM to fabricate duplicate

abutments for retrofitting an existing

implant prosthesis: A clinical report
Chonghwa Kim, DDS, MS,a Jong-Yub Kim, DDS, MSD, PhD,b and
Young-Jun Lim, DDS, MSD, PhDc
Dental Research Institute, School of Dentistry, Seoul National
University, Seoul, Korea
Computer-assisted design/computer-assisted manufacturing (CAD/CAM) technology has been widely used in the eld of
dentistry. Among CAD/CAM custom abutments, zirconia abutments are becoming more popular due to their favorable mechanical and esthetic properties. However, recent review articles show that fractured zirconia abutments are a common prosthetic complication. In this clinical report, a 72-year-old man presented with a dislodged implant-supported xed prosthesis
because of fractured zirconia abutments. This clinical report describes a successful application of CAD/CAM technology to
fabricate duplicate abutments, which were retrotted to the existing prosthesis. (J Prosthet Dent 2014;112:429-433)
Computer-assisted design/computerassisted manufacturing (CAD/CAM)
technology is becoming more prevalent in
the eld of dentistry. Advances in this
technology have expanded the scope of
its clinical applications.1-4 CAD/CAM
custom abutments have become widely
used in practice due to the clinical ease
and predictability in restorations. Among
various types of abutments available with
CAD/CAM, zirconia abutments have
gained popularity due to their favorable
mechanical and esthetic properties.5-12
Biomechanically, zirconia abutments

exhibit excellent biocompatibility, bend

strength, and fracture resistance as a
result of transformation toughening.13,14
Nevertheless, recent reports have shown
that the fracture of zirconia abutments is
a common prosthetic complication.15-20
Clinicians have known of the advantages of CAD/CAM dentistry for a long
time. The evolution of both hardware
and software systems has provided
versatility and operational freedom
with the CAD/CAM systems in use
today. These advances in technology
aid clinicians in managing prosthetic

complications associated with dental

implants that cannot otherwise be successfully managed with conventional
prosthodontic techniques. This clinical
report describes an application of CAD/
CAM technology to fabricate duplicate
abutments that were retrotted to the
existing implant prosthesis.

CLINICAL REPORT
A 72-year-old man presented to
the faculty clinic of Seoul National University School of Dentistry with a

1 Pretreatment intraoral views with dislodged implant prosthesis. A, Lateral view. B, Occlusal view.
Supported by the Korea Health R&D project (HI12C0064), granted by the Ministry of Health and Welfare, Republic of Korea.
a

Private practice, Seoul, Korea.

Private practice, Seoul, Korea.
c
Associate Professor, Department of Prosthodontics.
b

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2 Fractured cervical portion of existing zirconia abutments. A, Dislodged implant prosthesis with fractured abutments
inside. B, Existing prosthesis and abutment fragments.
dislodged implant prosthesis in the
maxillary left quadrant (Fig. 1). The patient declined the recommendation to
have a new prosthesis fabricated and
instead requested that the prosthesis
be repaired at minimal cost. Clinical examination revealed that both zirconia
abutments were fractured above the
implant platform, whereas the coronal
portion of the fractured abutments remained cemented inside the existing
prosthesis (Fig. 2). An impression of the 2
external-connection implants was made
with standard closed tray impression
copings (US Fixture Transfer Impression
Coping; Osstem) and polyvinyl siloxane
impression material (Compress heavy;
Bisico) (Fig. 3). A stone working cast was
then fabricated in the same manner as for
a conventional implant prosthesis.
For the CAD of the new abutments,
the working cast was scanned with

3 Standard closed tray impression copings positioned in

mouth for impression with polyvinyl siloxane material.
a digital laboratory scanner (Ez-scan
D-700; 3Shape). Two separate scan
data were obtained (Fig. 4). One scan
image was obtained with 2 scanning
bodies (Scanning abutment; Dentaim)
positioned on the working cast. The

fragments of the fractured abutments

were retrieved from the existing prosthesis
after heating in a ceramic furnace and
were reattached with an adhesive (Zapit;
Dental Ventures of America). The second
scan image was made with the reattached

4 Two separate scan images of working cast obtained with Ez-scan D-700 laboratory scanner. A, Complete arch scanning
with scanning bodies. B, Scanning with previous abutments in place.

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5 Computer-aided design for new abutments. A, Transfer of individual abutment scan. B, Completed transfer
of individual abutment scan. C, Redesigning fractured cervical part of new abutment. D, Completed design of
new abutment.

6 Two sets of new abutments fabricated from zirconia and titanium blocks. A, Previous abutments. B, New
titanium abutments. C, New zirconia abutments.

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7 Evaluation of new abutments with existing prosthesis. A, Titanium abutments placed in patients mouth. B, Existing
prosthesis positioned on new titanium abutments. C, Zirconia abutments placed in patients mouth. D, Existing prosthesis
positioned on new zirconia abutments.

abutments positioned on the working

cast. The 2 abutments were then individually scanned. The scan data for the
intact coronal portion of the abutments
were transferred to the CAD design for
the new abutments with a 3-point
matching technique (Fig. 5A, B). Subsequently, the CAD designs for the cervical
part of the new abutments were
completed (Fig. 5C, D).
Two sets of new abutments were
fabricated from zirconia (Z-match
block; Dentaim) and titanium blocks
(Z-match Titanium block; Dentaim)
(Fig. 6). The exural strength of zirconia block used ranged between 1000
and 1250 MPa, and its fracture
toughness was 5 MPa$m1/2. Both sets
of abutments and the existing prosthesis were then inserted into the patients mouth to evaluate t and
esthetics. The t of the patients existing prosthesis was clinically acceptable

with both types of the new

abutments (Fig. 7). Minor occlusal
adjustments were necessary at the time
of delivery. The patient chose the zirconia abutments for their esthetic
superiority.

SUMMARY
One of the limitations of ceramic
abutments is their brittle nature. As
a result, they are less resistant to tensile forces than are metal abutments.
With the development of high-strength
ceramics, especially zirconia, the mechanical disadvantages of ceramic
materials have been minimized. This
clinical report demonstrates the use of
CAD/CAM technology to provide an
efcient and precise way of fabricating
new abutments to replace fractured
abutments that support an existing
implant prosthesis.

The Journal of Prosthetic Dentistry

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Corresponding author:
Dr Young-Jun Lim
Department of Prosthodontics and Dental
Research Institute
School of Dentistry, Seoul National University
101 Daehak-ro, Jongno-gu, Seoul 110-749
KOREA
E-mail: limdds@snu.ac.kr
Copyright 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.