Precision of CNC-Milled

Titanium Frameworks for Implant

Treatment in the Edentulous Jaw

Torsten femt, LDS, Odont Dr*

Tomas Back, MS&
Anders Petersson, MS(f

Purpose: The purpose of this report was to describe a new technique to fabricate onepiece, implant-supported titanium frameworks by means of a computer numericcontroiied (CNO miiiing technique, and to compare the fit of these ramevvork with
conventionai cast prostheses. Materials and Methods: The study comprised 20 patients
who were provided with 5 standard Brnemark implants each in the edentuious
mandible. The fit of the first 10 prostheses with CNC-milled frameworks was measured by
means of a 3-dimensional photogrammetric technique. The distortion of the center point
of the framework cylinders was measured in relation to the master cast replicas. These
measurements were compared with 10 randomly selected routine prostheses with cast
frameworks. Results: No significant differences were found between the 2 groups. The
3-dimen5onal distortion of the cylinders in the compieted prostheses ranged from 3 to
80 (jm: no passive framework was observed. More distortion was observed in the
horizontai plane (x and y axes) as compared to the distortion in tbe vertical direction
2 axis). Conciusion: The precision of fit of the first CNC-milied prostbeses presented a
comparable fit to the conventionai cast frameworks, Consequentiy, tbis new technique
couid be a valid option for the routine fabrication of frameworks for implant prostheses.
int] Prosthodont 1999,-12:209-215.

using goid ailoy castings was to provide a more stabieocciusion in metai and to ai iow for porcelain veneering materials.'-- However, in many cases with severe bone rsorption, large amounts of goid aiioy had
to be cast when the occlusion was placed in metai.
These heavy frameworks caused casting problems
and the risk of distortion of the frameworks increased.
To compensate for the casting probiems associated
with the iost-wax casting technique and to improve
precision of the frameworks, premachined goid-aiioy
'Associate Professor and Head, Prosthodontic Division, The
cylinders were introduced on a reguiar basis in the
Brnemark Ciinic, Demat Health Care, Gteborg, Sweden.
'Manager, tmpiant Prosthetic Production, Nobei Biocare,
Brnemark impiant system (Nobel Biocare) at this
Gteborg, Sweden.
time.' The cyiinders were first cast into the frame^Manager, Electronics and Research Support, Nobel Biocare, work,^** but soldering and luting the cylinders to the
Gteborg, Sweden.
metai frame were aiso tried.'-^ To simpiify the implant
Reprint requests: Dr Torsten Jemt. The Brnemark Clinic, Public clinical and iaboratory protocol, further modificaDental Health, Mediciriaregatan 12 C, S-413 90 Gteborg,
tions to use more standardized bar framewori<s cast
Sweden. Fax: + 46(0131 82 73 29.
in semiprecious aiioys have been tested."*
e-maih torsten.iemt@odontologi.gu.se

dentulous patients have been treated with fixed

prostheses supported by osseointegrated impiants
ad modum Brnemark since 1965. The first patients
were provided with frameworks in Cr-Co alioy with
resin teeth.' This prosthetic protocoi was modified
overtime, and goid-aiioy castings were introduced for
impiant treatment in the eariy 1970s.' The reason for

2, Number 3. 1999

209

The Intemalioral lournal of Proslhodontif

Precision of CNC-Milled Titanium Frameworks

Table 1 Clinical and Laboratory Protocol Used to

Fabricate Fixed Prostheses with CNC-Milled Titanium
Frameworks
Patient visit

Laboratory

Clinic"

1
2
3

Final impression
Jaw recording
Functional and
esthetic assessment

4
5

F rame werk try-in

Final insertion

Tlie clinical protocol is the sa

im plant-sup ported prostlieses.

and all prostheses were made to fit 5 standard

Brnemark system abutment cylinders eacb. One
group of prostheses was made with titanium frameworks according to the new computer numericcontrolled (CNC] milling technique described below.
The second group of prostheses was a control that
used conventional cast frameworks with resin teeth.

iviaster cast trial base

Articulator tocth set up
Resin frame werk pattern
Laser scanning
CNC milling in titanium
Completion ot prosthesis

Reference Group
Ten edentulous patients who were treated witb standard fixed prostbeses with conventional cast frameworks"-'^ were randomly selected to form the control
group. These patients and prostheses have been described in more detail by Jemt and Lie.^^ Fabrication
of the frameworks was performed by two dental laboratories with experience of more tban 1,000 implant
cases eacb during more tban 10 years. All patients received a type III gold-ailoy casting witb standard
gold-alloy cylinders (DCA 072, Nobel Biocarej.The
frameworks were cast in one piece, and after try-in
of the metal frames resin teeth were cured to the
castings.'' Try-in of tbe prostheses was performed as
described below.

1 that used tor conventionally cast

Besides the conventional techniques for cast frameworks, other methods to manufacture prostheses for
implant rehabilitation have also been tested. One
such technique is to use prostheses based on carbon/
graphite fiber-reinforced poly (methyl methacrylate)^;
these prostheses have been shown to function well
in clinical foliow-up studies,'' Another noncasting
approach is to use laser-welded titanium frameworks,^'^ These frameworks are based on prefabricated titanium components, and different techniques
have been described for manufacturing the metal
frames.""^' Clinical experience with titanium frameworks has been encouraging, presenting results comparable to those reported for conventional casting
techniques.'*''' The most recent laser-welded prostheses (titanium type 3 frameworks) were manufactured by welding small, prefabricated titanium components fol lowed by manual contouringof the metal
beam by the technician before curing resin teeth to
the framework.'^'"'^ However, a major problem
with this technique is that the manual contouring of
the metal is too time consuming in the laboratory, and
further modifications of the titanium protocol therefore had to be considered.
A completely new protocol for fabricating titanium
frameworks has been developed, in which no laser
welding or prefabricated components are used. The
aims of the present study were to describe this new
technique for fabrication of fixed implant-supported
prostheses in theedentulous aw, to measure the precision of tbe fabricated prostheses to the master cast,
and to compare these measurements with the precision of routine conventional cast frameworks.

Test Graup
The test group comprised the first 10 consecutive
prostheses that were milled from one piece of titanium in a CNC milling machine. These prostheses
were randomly selected from patients that were
treated with fixed implant-supported restorations in
the edentulous mandible at one c l i n i c (The
Brnemark Clinic, GOteborg, Sweden) from January
to June 1997. The frameworks were fabricated by one
manufacturer (Nobel Biocare).
Clinical Procedures
The clinical restorative protocol was the same for the
2 groups (Table 1), basically following a routine 5appointment clinical procedure.^^ After completion,
all prostheses were clinically tested for acceptable fit.
This technique of clinical assessment has been described in more detail elsewhere.^^ In brief, tbe tryin was performed by following a protocol in which
the bridge locking-gold alloy screw was initially
tightened to the first resistance felt with the screwdriver.^^ From this position of the screw not more tban
half a turn of further tightening was accepted until
complete seating of tbe screw was achieved, using a
torque moment of 10 to 15 Ncm. When they were
clinically accepted, a 3-dimensional (3-d) photograph was taken of the master cast and the fit surfaces
of the prostbeses in the 2 groups (Fig 1).

Materials and Methods

The present study covered 2 different groups of fixed
prostheses tbat were manufactured and clinically accepted for final connection to implants in tbe edentulous mandible. Each group comprised 10 prostbeses.

i oi PfOBthodontit

210

Volume T2, Number?, ' " " "

leml el al

Precision of CNC-Milled Titanium Frameworks

Fig 1 Photograph of a complete CNC-milled prosthesis framework taken with the oamera equipment described. At least 3 images of the object are given in the same exposure.
Fig 2 (Rtghl) Trial base with final denture tooth arrangement
(top), framework resin pattern (middle), and final CNC-milled titanium framework (bottom). The titanium framework is a milled
copy of the scanned resin pattern in one piece.

Fig 3

Shape of the framework resin pattern is scanned.

Fig 4

Laboratory Procedure for CNC-Milled Titanium

Frameworks
The laboratory procedure (Table 1 ) followed the standard protocol, including fabrication of the master
cast, base try-in, and arrangement of artificial teeth
in the trial base."'''^ When the try-in o tooth arrangement was clinically accepted, a resin pattern was
made to reproduce the design of the final titanium
framework (Fig 2). This resin pattern was then placed
in a laser scanner to feed information on the contour
of the framework into a computer (Fig 3). Following
measurement of the positions of the implant replicas
in the master cast, a block of grade-2 titanium was
milled in a CNC milling macbine with 5 degrees of
freedom (Fig 4). An identical copy of the resin pattern
was acbieved in one piece of titanium (Fig 5). The

2, Number 3, 1999

211

Milling machine with the titanium framewori<.

CNC-milled titanium framework was refined by the

technicianandtriedforfit in the mouth of the patient.
Eventually, the prostheses were completed by curing
resin teeth to the metal superstructure, following standard procedures used for cast frameworks (Fig 6).
Pbotogrammetric Technique
A photogrammetric technique was used to measure
and compare the 3-d precision of fit of the complete
prostheses to the master casts.'^'^ This technique was
used with a standard small-format camera Pentax]
with a wide-angle lens (24 mm, 3.5 Vivitar]. The camera was provided with a glass plate with cross marks
in the film plane, and 2 parallel mirrors were placed
in front of the lens. This arrangement allowed several
images of the object in the same exposure (Fig 1 ),

The Internrion.

I of ProahodaritiC5

Precision of CNC-Milled Titanium Frameworks

Fig 5 fLeft; Completed CNC-milled titanium framework. Note that the oylinders are integral parts of tbe framework,
and tbers are no welding joints.
Fig 6 (Right) Completed prosthesis with
CNC-milied titanium framework and resin
teeth.

Table 2 Mean and Standard Deviation (SD) of Distance Between 2 Terminal Implants (Lateral) and Distance
Between Most Distal and Most Anterior Implants (Sagittal)
Lateral arch distance in mm
(x axis)

Sagittal arch distance in mm

(y axis)

y/x ratio (mm)

Group

Mean

SD

Range

Mean

SD

Range

Mean

SD

Range

Reference
CPJC-mitled titanium

30.7
28.9

2.1
3.2

27.2-33.9
24.6-33.1

8.4
7.3

1.0
1.7

7.1-1D.4
3.7-10.0

0.3
0.3

0.03
0.05

0,2-0.3
0.2-0.3

The photographs were placed in an analytic plotter under stereoscopic vision (Leica, Kern) for 3-d
measurements"''' of the prosthesis and master cast
replica cylinder center points (Atlas 2000, Metimur).
Each pair of measurements (master cast-framework)
was superimposed in the computer and analyzed for
optimal fit by means of the least squares method ,^''"'^''
Distortion of the frameworks was measured and reported in relation to the center point of the cylinders,
comparing the difference of x, y, and z positions as
well as the 3-d distortion for each individual cylinder.
The error of this measuring technique has been repotted in more detail elsewhere.^' Measurements f
the individual center points were calculated to a mean
3-d precision of 1 2 |jm in repeated measurements.

were also presented in absolute figures to show the degree of distortion without considering the direction of
the displaced cylinder, ie, left-right (x axis), anteriorposterior (y axis), or up-down (z axis). Wilcoxon's
ranked sum test^^ was used for statistical comparisons
between the 2 prosthesis designs. A P value of > 0.05
was not considered significantly different.

Results

Reference Group
Distortion of individual cylinders showed a wider
range in the horizontal plane (x and y axes) as compared to the vertical direction (z axis) (Table 3). The
range of mean 3-d distortion measured was from 16
to 80 |jm (Tables 3 and 4), with an overall mean 3-d
distortion of 42 pm (standard deviation 15 |jm).
Accordingly, no prosthesis showed a perfect fit.
When considering the direction of displacement,
the mean distortion in the 3 individual axes was on
average insignificant, but the standard deviations of
the means indicated more variation of misfit in the
horizontal plane (x and y axes; Table 4). When analyzing the same measurements as the mean of the
displacement in absolute figures (disregarding direction of distortion), the misfit in the horizontal
plane became more obvious as compared with the
sagittal displacement (2 axis] of the cylinder (Table
5), No pattern of distortion in relation to position of
the implants could be observed (Tables 4 and S).

Arch Form
All prostheses in the 2 groups were supported by 5
implants each, which were provided with standard
abutments. The width of the implant arch'^ was assessed by measuring the distance between the centers of the 2 most distal implants (x axis). The curvature of the arch was determined by measuring the
sagittal distance from a line between the 2 most distal implantstothecenterofthemost anteriorly placed
abutment (y axis). The measurements of the arch
forms of the 2 groups are given in Table 2.
Statistics
Conventional descriptive statistics were used to present
the distortion of the frarTieworks. The measurements

Tiie International louind of Prostiiodontics

212

Voliimpl2, Number3

Precision of CNC-Milled Titanium Frameworks

Jemt et al

Table 3

Maximal Range of Individual Center-Point Distortions of Frameworks (pm)

Reference group

CNC-milled titanium group

Min

Max

Range

Min

Max

Range

xaxis
y axis

-61
-53

-a4

124
118
64
64

-75
-68
-42
3

72
44
34
76

147

zaxis
3-d

63
65
40
80

16

112

76

73

Table 4 Mean and Standard Deviation (SD) of Distortion of Center-Point

Orientation of Frameworks (pm)'
Reference 1 group

Position

CNC-milled titanium group

3-d

3-d

1
Mean
SD

5
29

1
35

4
7

42
15

9
22

6
15

2
8

26
12

Mean
SD

6
26

4
35

-6
12

41
17

7
29

-11
27

20

40
20

Mean
SD

-16
32

-11
18

1
16

39
19

14
20

23

9
18

38
9

Mean
SD

9
29

3
34

7
20

47
7

-26
31

5
24

-6
13

35
19

Mean
SD
Total
Mean
SD

7
36

9
27

5
9

42
19

-26
34

-9
23

2
8

44
21

0
30

Q
30

0
15

42
15

0
30

0
30

2
17

37
18

2
-am

3
11

Mean error vector ot center peint trom right (position 1) to iett (position 5).

Table 5 Mean and Standard Deviation (SD) of Distortion of Center-Point

Orientation of Frameworks in Absolute Figures (Mm)'
CNC-miiled titanium group

Reference group
Position

3-d

3-d

42
15

18
15

12
10

6
5

26
12

6
11

41
17

25
14

21
21

15
14

40
20

15
16

12
10

39
19

18
13

19
14

14
12

38
9

25
15

28
17

15
13

47
7

22
20

20
12

12
8

35
19

28
23

23
15

8
7

42
19

36
22

18
15

8
4

44
21

25
17

25
17

10
9

42
15

24
18

19
15

11
10

37
18

Mean
SD

24
16

28
19

6
4

Mean
SD

19
17

31
14

Mean
SD

30
18

Mean
SD
Mean
SD
Total
Mean
SD

Mean absolute error vector ot center poinl from nght (position 1 to left (position 5].

: Number 3,1999

213

The [ntemationaI lournai of ProthodenticB

Precision of CNC-Milled Titanium Frirreworks

The distortion of the cast impiant framework has eariier been shown to increase as the curvature of the Impiant arch and the weight of the casting olioy increase."'These inherent variabies for then i.iventionai
iost-wax casting technique are not present lur the CNC
miiiing procedure. This aiiows for better fii of the titanium frameworks in difficult ciinicai cases with many
implants in large, curved impiant arches. Some ciinicians have refrained from using porceiain-fused-tometai impiant prostheses in the severeiy resorbed edentuious jaw because of the cost and fit probiems
associated with conventionai goid aiioy castings. The
CNC miiiing procedure provides a solution to this fit
probiem, as the macbining of the fit surfaces of the
framework is not affected by the totai amount of metal
in the superstructure. Accordingly, CNC-miiied titanium frameworks can also be considered for rehabiiitation with prostheses with porcelain veneers in the
severeiy resorbed edentuious jaw (Fig 7).
The ciinicai performance of fixed impiantsupported prostheses with titanium frameworks has
shown resuits comparabie to those found for conventionai restorations,^'""'"' Few severe probiems
bave been reported by these patients, and none of
these problems has been positively associated with
the metai in tbe superstructure,'^ iHowever, even
though some studies have reported few, if any, fractures of the titanium metal frames,"''^ others have observed a siightiy higher incidence of fractured frameworks for the titanium prostheses,'"* These fractures
have been in reiation to the welding joints. With a
penetration depth of about 0.6 mm in theweid,^''this
area must be considered to be the weak part of the
framework and shouid not be adjusted by grinding
after completion,'^"''' it is reasonabie to assume that
the risi< of fractures of the metai framework wouid be
significantiy reduced by fabricating the metai superstructure from one soiid biock of titanium.
As discussed above, the CNC miiiing procedure
eliminates probiems with distortion caused by conventionai iost-wax casting techniques, tbereby aiiowing for more predictabie manufacturing of the
frameworks to the master casts, ' ' iHowever, the iimitation of this new technique is that the intraoral fit of
the framework wiii never be better than the accuracy
of the master cast."'^'' Since the master cast never presents an exact orientation of the intraorai impiants-^^
it shouid be of interest not only to optimize the fit of
the framework to the master cast, but aiso to further
improve the accuracy and the precision of the registration of intraorai impiant position. Since this CNC
miiiing technique was introduced, it has become possibie to use new digital means for recording impiant
orientation based on numeric impiant position data
from the master cast. Recent exprimentai ciinical

Fig 7 Conventional prosthesis with cast gold-alioy tramework

and resin teeth (top replaced by CNC-milled titanium framewort^
with porcelain veneers [bottom).

CNC-Milled Titanium Group

The range of distortion of the center points of the
CNC-miiled titanium frameworks was on a similar
ievei to that observed for tbe reference group (Tabie
3). Misfit with regard to direction of dispiacement
(Table 4) as weli as in absoiute figures (Tabie 5) was
also in accordance with the cast goid-aiioy frameworks. No significant differences of distortion of frameworks couid be found between the groups (P>0.05|.
Discussion
This paper presents a compieteiy new technique to
fabricate frameworks for impiant-supported prostheses with precision comparabie to that found in conventionai cast frameworks made by very experienced
iaboratories. Since these first 10 prostheses were
made, another 600 CNC-miiied titanium frameworks
have been fabricated duringthe first year, indicating
that this new laboratory procedure (AI i-in-One, Noliel
Biocare) is a vaiid alternative to conventional techniques for routine impiant rehabiiitation.
One of the reasons for deveioping a laboratory
procedure for titanium frameworks was to try to improve the fit of the superstructures to the impiants by
avoiding some of the inherent probiems associated
with the iost-wax casting technique.'^''' By using an
industriai manufacturing protocoi for the frameworks,
many factors reiated to manuai handiing of the conventionai castings can also be controiied and
avoided. As shown in the present study, even the first
ciinicai cases reached a ievel of fit that compares favorably with cast prostheses from weii-established
iaboratory teams. Even though there is no data avaiiabie to indicate that a better fit than that presented
here is needed,'*-'^''"'^^ it is reasonable to assume that
the precision of the CNC-milied frameworks may be
further improved by additional refinement of the laser
scanning and CNC miiiing procedures.

The Iniernational Journal of Prosthodontics

214

Volume 12, Number 3,1999

leint et a\

Precisicn of CNC-Milied Titanium Frameworks

studies have measured bone and framework deformations caused by misfit,-^ soft tissue volume adjacent
to implants,-' and oral implant positions^^ by means
of the photogram metric technique used in the present
study. These recent studies indicate a new option for
recording implant positions without using conventional impression procedures.

12.

Bergendai B, Palmqvist S. Laser-welded titanium frameworks for

fixed prostheses supported by osseointegrated implants: A 2-year
multicenter sludy report, Int | Oral Maxillofac Implants 1995;
10:199-206.

1 3.

Jemt T, Bergendai B, Arvidssor K, Bergendai T, Karlsson U.

Linden B, el al. Laser-welded titanium frameworks supported by
implants in the edentulous maxilla: A 2-yeaf prospective multicenter study. Int J Prosthodont 1998,11.558-564.

14.

rtorp A, Linden B, |emt T. Ciinical experiences with laserwelded titanium frameworks supported by implants in theedentulous mandible: A 5-year follow-up study. Int J Prosthodont
1999;12:65-72.

15.

Jemt T. Failures and complications in 391 consecutively inserted ilxed prostheses supported by Brnemark implants in the
edentulous iaw: A study of treatment from the time of prosthesis placement to the first annual check-up. in[J Oral Maxillofac
Implants 1991:6:270-276.

16.

Jemt T, Lie A. Accuracy of implant-supporied prostheses in the

edentulous iaw. Analysis of precision of fit between cast goldalloy frameworks and master casts by means of a threedimensional photogram metric technique. Clin Oral Implants
Res1995;6:l72-l8O.

17.

Lie A, Jemt T. Photoe'a'^rr'el'ic measurements of implant positions. Description of a technique to determine the fit bet\veen impiants and superstructures. Ciin Orai Implants Res 1994;5:30-36.

18.

AlbertzJ, Krieiing W. Photogrammetrisc h es Taschenbuch, ed 3.

Karlsmhe, 1980,

19.

Carsell B. ATLAS 2000. Computer Program Manual. Gteborg:

Metimur, 1987.

20.

Hinskens L, Cogar L, Kotowski R. A new MS-DOS based integrated sofhvare pacl<age for triangulation and data collection for
close range appiications (part B5, commission V). Int Arch
Photogram Remote Sens 1992:29:11-18.

21.

JemtT, Rubenstein JE, Carlsson L, Lang B, Measuring fit at the impiant pnisthodontic interface. ) Prosthet Dent 1995,75314-325.

Acknowledgments
The CNC tramework prostheses used in thi study were fabricated
by Mr Tond |alevi<. Special Product Laboratory, Nobel Biocare
Nonden, Gteborg, Sweden. The studv was supported hy grants
from Nobel Biocare and Mr Sven-Olav lohansson, Metimur,
Gteborg, Sweden.

References
1.

2.

3.
4.

5.

6.

7.

8.

9.

10.

11.

Brnemark P-I, Hansson BO, Adeli R, Breine U, Lindstrm J,

Hallen O, hman A. Osseointegrated Implants in the Treatment
of the Edentulous Jaw. Experience trom ^ 10-Year Period.
Stocliholmj Aimqvist & Wikseli, 1977.
Bergman B. Evaluation of the result of treatment with osseointegrated implants by the Swedish National Board of Health and
Welfare. J Prosthet Dent 1983;50:114-115.
LundqvisiS, Carlsson OE. Maxiiiary fised prostheses on osseoiniegraied dental implants. J Prosthet Dent 1983;50:362-270.
Zarb G, Jansson T Prosthodontic procedures. In: Brnemark PI, Zarb C, Aibrektsson T (edsl. Tissue-Integrated Prostheses.
Osseointegration in Ciinicai Dentistry. Chicago' Quintessence,
1985.241-282.
Siiril HA, Nordberg L, Oikarinen VJ. Technique for convetting
an existing complete denture lo tissue-integrated prosthesis. I
Prosthet Dent 1988;59:463-467.
Bjork N, Ekstrand K, Ruyter LE. implant-fixed dental bridges fmm
carbon/graphite tlbre reinforced poly(methyl methacrylate).
Biomaterials 1986:7:73-75.
Bergendai T, Ekstrand K, Karlsson U. Evaluation of implantsupported cartwrVgraphitefiber-reinforcedpolylmethyl methacryiate} prostheses. Clin Oral implants Res 1995;6:346-253.
JemtT. Modified singie and short span restorations supported by
osseointegrafed fixtures in the partiaiiy edentulous jaw. ] Prosthet
Dent19B6;55:243-246.
lemt T. Linden B. Eixed implant-supported piostheses with welded
titanium frameworks. Int I Periodontics Restorative Dent 1992:
12:177-184.
Jemt T. Three-dimensional distortion of gold alloy castings and
welded titanium frameworks. Measurements of the precision of
fit between completed implant prostheses and the master casts in
routine edentulous situations. I Oral Rehabil 995;22:557-564.

22.

Colton T. Statistics in Medicine. Boston; Little Brown, 1974:

219-228.

23.

Jemt T, Book K. Prosthesis misfit and marginal bone loss in

edentulous implants patients. Int J Oral Maxillofac Implants
I996;l1:620-625.

24.

Sjgren C, Andersson M, Bergman M. Laser welding of titanium

in dentistry. Acta Odontoi Scand 1988,46:247-253.

25.

Jemt T. in vivo mi^asurements of precision of fit involving

implant-supported prostheses in the edentulous iaw. Int J Oral
Maxillofac Implants 1996:11:151-158.

26.

Jemt T, Lekhoim U. Measurements of bone and framework deformations induced by mistlt of implant superstructures. A pilot
study in rabbits. G i n Oral Implants Res ! 998:9:272-280.

27.

JemtT, Book K, Lie A, BrjessonT. Mucosal topography around

implants in the edentulous upper aw. Photogram metric threedimensional measurements of the effect of replacement of removable prosthesis with a fixed prosthesis. Clin Oral Implants
Res 1994:5:220-228.

Rubenstein JE. Stereo laser-welded titanium implant frameworks:

Clinical and laboratory procedures with summary of -year
clinical trials. J Prosthet Dent 1995:74:234-293.

215

The Intern a liona i Journal of Prosthodontii