RESTORATIVE DENTISTRY
Metal-free implant-supported single-tooth restorations.
Part II: Hybrid abutment crowns and material selection
Daniel Edelhoff, Prof Dr med dent/Josef Schweiger, CDT, MSc/Otto Prandtner, MDT/
Michael Stimmelmayr, Prof Dr med dent/Jan-Frederik Güth, PD Dr med dent
In many areas of restorative dentistry, metal-free materials offer
an alternative to metal-based restorations while ensuring high
levels of biocompatibility and esthetics. Rapidly evolving CAD/
CAM technology has significantly expanded the range of mater-
ials available, providing access to materials classes and their
combinations not previously available within conventional
manufacturing, such as zirconia ceramics and hybrid ceramics.
In addition, digital methods offer previously unavailable op-
tions in diagnostics, greater planning reliability, better material
quality through standardization of the manufacturing process,
and reproducibility – significant benefits that can be used to
advantage, especially in oral implantology. Even though tech-
nological progress in the field of metal-free materials has given
rise to considerable improvements in their mechanical proper-
ties over the decades, their clinical long-term success is still very
much dependent on an appropriate indication and proper
The development of computer-aided design/computer-assisted
manufacture (CAD/CAM) technology and the introduction of
digital workflows have given rise to numerous new options in
recent decades: in three-dimensional implant planning, in the
manufacturing of implant abutments, and also in terms of the
available range of superstructure materials.1-5 The focus is pri-
marily on materials such as titanium, zirconia ceramics, or lithium
(di)silicate ceramics, and increasingly also on polymer-based
materials.6-9 There are therefore many new ways to fabricate
custom implant abutments and to restore them using metal-
free single-tooth restorative designs as described in part one of
this article.5,8,10-13
260 QUINTESSENCE INTERNATIONAL | volume 50 • number 4 • April 2019
material selection, on the knowledge and skills of the dental
practitioner and dental technician, and on an adequate occlu-
sion concept. The high rate of innovation – both with regard to
the materials themselves and to CAD/CAM technology – there-
fore requires an adequate level of prior knowledge to sensibly
and successfully implement the wide range of possibilities. It is
becoming more and more puzzling for users to find their way
around the many different new techniques and materials. This
review article provides an up-to-date overview of the possibili-
ties and limitations of metal-free implant-supported single-tooth
restorations. This second part discusses hybrid abutment crowns
and materials selection. Resultant treatment concepts are pre-
sented and evaluated based on clinical examples. (Quintessence Int
2019;50:260–269; doi: 10.3290/j.qi.a42099. Originally published in
German in Implantologie 2018;26(4):353–370)
Besides the classic approach using an abutment and a
cemented crown, there is an alternative approach using directly
screw-retained hybrid abutment crowns for single-tooth res-
torations, which are described in this second part.
Hybrid abutment crowns
The introduction of prefabricated lithium disilicate blanks with
an industrially prefabricated connection geometry for titanium
adhesive bases has revolutionized the fabrication of metal-free
implant-supported single crowns for almost all implant systems
(Fig 1).11,14,15 For this – exclusively screw-retained – concept, the
 Edelhoff et al

1 2

Fig 1 CAD/CAM blank made of lithium disilicate (IPS e.max CAD, Ivoclar Vivadent) in pre-crystallized condition for definitive implant-
supported single-tooth restorations (hybrid abutment crown, fourth generation ceramic abutments) with connection geometry for a
Cerec titanium base (Dentsply Sirona).
Fig 2 CAD/CAM blank based on PMMA (Telio CAD, Ivoclar Vivadent) with connection geometry for a Cerec titanium base (Dentsply Sirona)
for the fabrication of implant-supported long-term provisional single-tooth restorations.

metal-free implant abutment and the implant crown are com-
bined into a single unit, simplifying the entire manufacturing
process and reducing it to two steps. In the first step, the lithium
disilicate blank is milled into the appropriate shape and receives
its final strength and shade in a crystallization firing cycle. In the
second step, the result is bonded to the titanium base.
Previously, the digital production of a metal-free restoration
on a single-tooth implant had only been possible by using a
zirconia abutment with a specific connection to the implant or
to the titanium adhesive base (monolithic CAD/CAM zirconia
abutment or CAD/CAM hybrid abutment plus separate crown).
Prefabricated blanks with an integrated connection to the tita-
nium base can be used for provisional polymethyl methacry-
late (PMMA)-based (Telio CAD, Ivoclar Vivadent; or Vita CAD
Temp, Vita Zahnfabrik) and definitive immediate restorations
for implants (such as IPS e.max CAD, Ivoclar Vivadent; or Enamic,
Vita Zahnfabrik) using a powder-free intraoral scanner during
at the delivery appointment or on re-entry (Munich Implant
Concept, MIC) (Figs 1 and 2).4,5,16
In principle, a hybrid abutment crown can also be produced
in a conventional workflow. Prefabricated titanium bases from
various manufacturers are available for this purpose, whose
height can be reduced if specific guidelines are followed (Fig 3).
The abutment crown can be modeled in wax and transferred to
lithium disilicate using the pressing technique. It is expedient to
try in the hybrid abutment crowns before bonding in order to
correct the shade if required or to adjust proximal and occlusal
contacts. For this purpose, the hybrid abutment crowns on the
titanium base can be tested either with a white low-viscosity sili-
cone material (such as Fit Checker Advanced, GC; or Virtual Light
Body, Ivoclar Vivadent) or with a provisional eugenol-free white
adhesive cementing agent (such as Temp Bond NE, Kerr Dental).
This procedure additionally allows the ceramic abutment crown
portion to be returned to the furnace for a new stain and glaze
firing or to correct the shade and shape in another firing cycle.
This would be impossible after bonding, as furnace temperatures
would destroy the adhesive bond. Definitive bonding can be per-
formed on the cast. The contact surface of the hybrid abutment
crown is first etched (for lithium disilicate: 20 seconds with hydro-
fluoric acid < 5%, such as IPS Ceramic Etching Gel, Ivoclar Viva-
dent) and then silanized (eg, by exposure to the effective silane
content in Monobond Plus, Ivoclar Vivadent, for 60 seconds). With
the Variobase titanium base (Institut Straumann), the titanium
surface does not need to be air-particle abraded thanks to the
pronounced retentions present, according to a statement by the
manufacturer. After careful degreasing, an adhesion primer can
be applied to the titanium surface (eg, by exposure to the effec-
tive sulfide methacrylate content in Monobond Plus). During
final bonding with a chemically curing resin adhesive specially
optimized for this indication (Multilink Hybrid Abutment, Ivoclar
Vivadent), it is recommended to obturate the screw access holds
of the titanium bases with plastic pellets (eg, Pele Tim, Voco) to
protect them from the adhesive (Fig 3). Sterilization in the auto-
clave after bonding does not appear to have an adverse effect on

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 RESTORATIVE DENTISTRY

3a 3b

Fig 3a Conventionally produced two-piece hybrid abutment crowns. Prefabricated titanium bases (Variobase, Institut Straumann) with
corresponding abutment crowns made of lithium disilicate ceramic (IPS e.max Press multi, Ivoclar Vivadent) conventionally fabricated using a
wax-up and the pressing technique.
Fig 3b After the clinical try-in and any adjustment to shape and shade, the lithium disilicate abutment crown (IPS e.max Press multi,
Ivoclar Vivadent) is etched for 20 seconds with < 5% hydrofluoric acid and connected to the prefabricated titanium base (Variobase,
Institut Straumann) at the laboratory (hybrid abutment crown, fourth generation).

the bond between the titanium adhesive base and the abutment
crown.17 After insertion with a torque wrench, the screw access
holes are protected with a polytetrafluoroethylene (PTFE) tape
and adhesively sealed against the oral cavity with a highly filled
composite resin (Fig 4). In-vitro investigations of the load at frac-
ture of hybrid abutment lithium disilicate crowns showed that
the strength-limiting factor was not the ceramic material but the
abutment screw.11 Further in-vitro studies have shown that the
lower strength of monolithic lithium disilicate hybrid abutment
crowns compared to monolithic zirconia crowns was actually a
benefit in that it protected the supporting implant from over-
load.15,18 In an in-vitro study, screw access holes – indispensable
with this design – resulted in reduced strength of the restorations
compared to ceramic crowns without screw access.8

Fig 3c Preparation of the master cast for

bonding the etched all-ceramic crowns
(IPS e.max Press multi, Ivoclar Vivadent) with
the carefully degreased prefabricated tita-
nium bases (Variobase, Institut Straumann).
The screw access holes in the titanium bases
are protected from penetrating adhesive by
closing them with plastic pellets.
Fig 3d Situation following adhesive ce-
menting on the master cast. The conditioned
3c 3d and carefully cleaned surfaces had been
wetted with a primer (Monobond Plus,
Ivoclar Vivadent) and bonded with a special,
extremely opaque adhesive (Multilink
Hybrid Abutment, Ivoclar Vivadent). The ex-
cess can now be carefully removed from the
transition area between the abutment crown
and the titanium base (adhesive joint).
Fig 3e Clinical situation after the two
implants have healed (Bone Level, 3.3 mm
diameter; Institut Straumann) in a patient
with multiple congenitally missing teeth.
Fig 3f Situation following the insertion
of the hybrid abutment crowns (fourth
generation). (Laboratory procedures:
3e 3f Evelyn Neubauer, MDT, Landshut, Germany).

262 QUINTESSENCE INTERNATIONAL | volume 50 • number 4 • April 2019

 Edelhoff et al

4a

Fig 4a Clinical situation following implant

insertion (Tissue Level, 4.1 mm diameter;
Institut Straumann) at site of the mandibular
right first molar (position 46) as part of a
comprehensive rehabilitation that included
a change in the vertical dimension of
occlusion (VDO).
Fig 4b Monolithic lithium disilicate crowns
(iPS e.max Press, shade HT; Ivoclar Vivadent)
on the mandibular right canine, first and
second premolar (teeth 43, 44, 45), and 4b 4c
second molar (tooth 47) and a hybrid abut-
ment crown to replace the mandibular right first molar (tooth 46) (IPS e.max Press, shade Multi; Ivoclar Vivadent) (fourth generation.)
Fig 4c Situation following the adhesive connection of crowns on the mandibular right canine, first and second premolar (teeth 43, 44, 45),
and second molar (tooth 47). The screw access holds of the implant-supported hybrid abutment crown 46 (mandibular right first molar) was
closed adhesively with PTFE tape and composite resin after tightening with a torque wrench. All occlusal surfaces have the same chemical
composition and exhibit comparable wear behavior.

Advantages Material selection and material combina-

■ Simplified manufacturing process compared to hybrid
abutments plus separate crown, as the ceramic abutment
and crown are combined into a single component.
■ No cementing joint and no risk of damage by excess
cementing material.
Disadvantages
■ Manual bonding of the custom abutment crown to the tita-
nium adhesive base in correct alignment is required.
■ Risk of retention loss due to improper bonding.
■ No long-term clinical evidence.
■ More limited choice of path-of-insertion options, which
depend on the proximal contacts in relation to the internal
geometry of the implant.
tions for metal-free superstructures
Many other combinations of materials for implant superstruc-
ture are conceivable. Especially in the case of complex rehabil-
itations in both arches, the authors consider it important to
ensure uniform wear resistance of the occlusal surfaces, avoid-
ing combinations of different materials such as monolithic lith-
ium disilicate ceramics and monolithic zirconia ceramics
(Fig 5).15,19 Where masticatory loads are high, available data
indicate that custom CAD/CAM one-piece titanium abutments
– with a ceramic component – appear preferable outside the
esthetic zone.20,21 These can later be restored with metal-free
crowns made of monolithic lithium disilicate ceramics or a
combination of a zirconia framework sintered with a lithium
disilicate veneer by a fusion ceramic (CAD-on technique; Figs 6a
and 6b).3,15,22 This technique would also ensure that antagonists
in a full-arch rehabilitation, for example lithium disilicate,

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 RESTORATIVE DENTISTRY
One-piece prefabricated One-piece CAD/CAM
• Alumina • Zirconia
• Zirconia • Custom CAD/CAM
Fig 5 The four generations of ceramic implant abutments. Between 1993 and 2013, various concepts (generations) for manufacturing ceramic
implant abutment were introduced: the one-piece (monolithic) prefabricated abutment (first generation), the CAD/CAM one-piece (mono-
lithic) abutment (second generation), the two-piece hybrid abutment plus a separate crown (third generation), and finally, introduced in 2013,
the two-piece hybrid abutment crown (fourth generation).
exhibit comparable wear behavior (Figs 6c to 6e).19 In a pro-
spective clinical study of three-unit zirconia fixed dental pros-
theses, a significantly lower incidence of major chipping was
observed after 1 year in fabrications using the CAD-on veneer-
ing technique compared to manually veneered fixed dental
prostheses.22 Monolithic lithium disilicate crowns on one-piece
titanium abutments achieved the highest strength in an in-vi-
tro study compared to other glass-ceramic and polymer-based
crowns; they should therefore be reliable to use in long-term
restorations in the posterior region.8 This has been confirmed
by a long-term clinical study that found a survival rate of 93.8%
for lithium disilicate crowns on implants after 10 years.23 The
strength limit of monolithic lithium disilicate crowns could be
advantageous in terms of protecting the implant substructures.
In-vitro studies found no damage to the implant at loads below
the breaking load of the lithium disilicate superstructure.8,15 In
monolithic zirconia crowns, on the other hand, permanent
damage to the implant was seen when the breaking load was
reached, which could result in explantation in a clinical situa-
tion.7 Even though the results of in-vitro studies have very lim-
ited applicability to clinical situations, they can provide import-
ant information for adequate material selection.
An alternative to all-ceramic restorations could be poly-
mer-based crowns. A very wide range of CAD/CAM blanks made
from industrially prefabricated hybrid ceramics, composite resins,
and polyetheretherketone (PEEK) materials is already available.7,8,25
264 QUINTESSENCE INTERNATIONAL | volume 50 • number 4 • April 2019
Hybrid abutment Hybrid abutment crown
• Titanium base, • Titanium base,
prefabricated prefabricated
• Zirconia or lithium • Lithium disilicate or
disilicate, custom zirconia, custom
To the best of the authors’ knowledge, there is still no or
only insufficient long-term clinical data on this type of res-
toration on implants. However, in-vitro studies have demon-
strated that CAD/CAM composites do not even come close to
achieving the strength values of lithium (di)silicate glass-
ceramic crowns.7,8 Nor does it seem to be sufficiently certain
whether this class of material achieves clinically sufficient long-
term wear stability in the load-bearing posterior region (Fig 7).25
Furthermore, a clinical study of crowns made of CAD/CAM
composites (Lava Ultimate, 3M Espe) on zirconia abutments
showed dramatic early failure rates.26 Crowns made of hybrid
ceramics (Enamic) and crowns made of PEEK, on the other hand,
might meet the requirements for definitive tooth-colored
implant-supported single-tooth restorations.7,8 A conclusive
assessment would presuppose results from long-term clinical
studies.
Discussion
The success of a metal-free implant-supported single-tooth res-
toration depends on a number of factors. In addition to biologic
factors, such as the bone supply, the position and length of the
implant, the condition of the peri-implant soft tissue, the occlu-
sal situation, and the presence or absence of bruxism,18,27 techni-
cal aspects are the paramount factors in determining clinical
long-term success. These technical aspects include the choice
 Edelhoff et al

Figs 6a and 6b CAD/CAM 6a 6b

custom one-piece titanium abut-
ment for an implant-supported
restoration on the mandibular
right second molar (tooth 47) in
a patient characterized by high
masticatory loads. The all-ceramic
crown was manufactured using
the CAD-on technique.
It has a CAD/CAM zirconia frame-
work structure to which a corre-
sponding CAD/CAM lithium
disilicate veneer (IPS e.max CAD,
shade HT; Ivoclar Vivadent) was
sintered using a fusion ceramic
material (IPS e.max CAD Crystall./
Connect).

Fig 6c Finished restorations as

part of a comprehensive rehabili-
tation with a change in vertical
dimension of occlusion. The
all-ceramic implant-supported
crowns 46 and 47 (mandibular
right first and second molar)
were fabricated using the
CAD-on technique, while the
CAD/CAM-milled crowns on the 6c
natural teeth were fabricated us-
ing monolithic lithium disilicate
(staining technique; IPS e.max
CAD, Ivoclar Vivadent).

6d 6e

Fig 6d Clinical situation following removal of the provisional restorations.

Fig 6e Clinical situation following adhesive placement of crowns 44, 45 and 48 (mandibular right first and second premolar and third molar)
and conventional cementation (glass-ionomer cement, Ketac Cem, 3M Espe) of CAD-on crowns on implants 46 and 47 (mandibular right first
and second molar). The surfaces of all restorations, including those in the maxilla, are made of same material in the occlusal surface area and
therefore exhibit comparable wear behavior.

and combination of materials, the production method, the avail-
able space, the type of retention (cemented or screw-retained),
and the occlusal concept.21,28,29-31 The treatment team can influ-
ence the treatment success by making correct decisions regard-
ing the design and method of fabrication of the implant abut-
ment and definitive restoration.7,8,15,29 Here, prefabricated
abutments often reach their limits. They offer less satisfactory
solutions than custom abutments in many cases.32 At this point,
the focus is on custom CAD/CAM abutments, which can be opti-
mally adapted to the clinical situation in terms of both axial incli-
nation and sub- and supragingival shape. Their greatest clinical
advantage is that the abutment can shape the emergence con-
tour. With cemented restorations in particular, the removal of
excess classic cements is considerably simplified, since the crown
margin can be adapted to the gingival contour and placed in in
an area where it can be controlled. With the introduction of

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 RESTORATIVE DENTISTRY

7a

7b 7c

Fig 7a Occlusal onlays and hybrid abutment crown made of an experimental CAD/CAM composite as part of a comprehensive rehabilitation
with a change in vertical dimension of occlusion.
Fig 7b Occlusal onlays made of an experimental CAD/CAM composite resin after adhesive connection and tightening of the hybrid abutment
crown with a torque wrench on an implant with an internal connection (Replace select, Nobel Biocare).
Fig 7c Clinical situation after 36 months of clinical service. Extreme signs of wear on the CAD/CAM composite are visible in the areas of
occlusal contact.

CAD/CAM, the required time and effort became economically
feasible while at the same time ensuring gentle treatment of
the material. Manual adjustment of prefabricated abutments,
on the other hand, carries the risk of overheating and affords no
control over the remaining wall thickness, which are highly rel-
evant for the stability of ceramic restorations in particular. CAD/
CAM fabrication of custom abutments from tooth-colored
materials has therefore now become an established method.15,21
A fundamental question is whether metal-free single-tooth
restorations should be cemented or screw-retained.33 From a
scientific point of view, the two forms of retention differ only
insignificantly in terms of technical complications.29,30 The risk
of screw loosening was slightly higher than the risk of cement
retention loss when looking at single crowns.34 However, only
clinical studies with an observation period of more than 5 years
were included in the relevant systematic review, so most
implant systems evaluated had an external interface between
the implant and abutment. The trend among implant manufac-
turers toward internal connections has resulted in significantly
fewer instances of screw loosening,34 but at the same time it
has increased the fracture risk of one-piece zirconia implant
abutments in certain clinical situations.21,28 As for biologic com-
plications, excess cement in the sulcus may be a major cause of
inflammation of the peri-implant tissue. A clinical trial by Wil-
son36 used dental endoscopy to demonstrate the association
between excess cement and peri-implantitis. Excess cement in
the sulcus was associated with peri-implant inflammation in
81% of cases. Once the excess cement had been removed, the
peri-implantitis healed completely in 74% of cases.
In terms of excess removal, adhesive cementing agents
appear to present a much higher risk than conventional
cements. An in-vitro study demonstrated that single crowns
connected to titanium abutments using a resin adhesive
resulted in ten times as much excess material even after careful

266 QUINTESSENCE INTERNATIONAL | volume 50 • number 4 • April 2019


removal than crowns cemented with classic cementing agents,
such as glass-ionomer or zinc-oxide/phosphate cements, under
the same conditions.37 Classic glass-ionomer cements are
therefore an interesting alternative for use with high-strength
ceramics (lithium disilicate and zirconia); they provided suffi-
cient retention for implant-supported crowns in in-vitro stud-
ies.38,39 In addition, the amount of excess material can be signifi-
cantly reduced by a special adhesive technique that optimizes
the amount of adhesive introduced at delivery.33
Metal-free single-tooth restorations can also be screw-
retained to completely eliminate the risk of excess cement
while at the same time providing retrievable superstructures.
The advantage of retrievability, however, is balanced by the dis-
advantage of having to provide an occlusal screw channel. In
some cases, the alignment of the implant axis will rule out a
screw-retained solution, for example if the screw axis channel
would be located labially in the anterior region.40 If a screw-re-
tained restoration is preferred, the question also arises as to
whether a zirconia framework is required for a ceramic or other
tooth-shaded restoration.15
An alternative solution is restoring single-tooth implants
with hybrid-abutment lithium disilicate crowns, which can be
fabricated using the pressing technique (IPS e.max Press, Ivo-
clar Vivadent) or CAD/CAM.
With CAD/CAM, the connection with the titanium adhesive
base is already provided by the manufacturer; only the external
geometry is processed by the CAD/CAM system. In these hybrid
abutment crowns, the abutment and crown are merged to form
a coherent structure (see Figs 1, 5, and 7). This “streamlining” of
the restoration represents a very efficient alternative to conven-
tional metal-free crowns on hybrid abutments as there is no tran-
sition between the abutment and the restoration. In addition to
the biologic benefits, there could also be an esthetic advantage,
because even if the abutment becomes exposed due to soft-tis-
sue recession, it will not present with a different color. In addi-
tion, lithium disilicate ceramics are easier to bond to the titanium
base than zirconia (Fig 3b). Attempts to perform air-particle abra-
sion as required to activate zirconia surfaces, on the other hand,
will yield suboptimal results due to the specific geometry of the
hybrid abutments. It should be noted, however, that only few
in-vitro studies of this concept have been carried out and that
scientifically reliable clinical data are still pending.11,15,41 Also, the
reaction to the lithium disilicate of the soft tissue in the peri-im-
plant emergence space should be investigated and compared
with today’s standard materials, titanium and zirconia.42,43
Nor do sufficient long-term clinical data exist for polymer-
based single-tooth restorations. CAD/CAM composite-resin
QUINTESSENCE INTERNATIONAL | volume 50 • number 4 • April 2019
Edelhoff et al
crowns did not even come close to achieving the same strength
as lithium (di)silicate crowns in in-vitro studies.7,8 As already
mentioned, it is not yet sufficiently certain whether this mater-
ial class can provide stable long-term stable wear resistance in
the load-bearing posterior arch.25 In a clinical study of crowns
made of a CAD/CAM composite (Lava Ultimate) on zirconia
abutments, 80% of CAD/CAM composite crowns showed a loss
of retention after only 1 year; 6% of crowns had fractured.26 No
retention loss occurred In the control group with lithium disili-
cate crowns on identical abutments and using the same
cementing agent.26 Crowns made of hybrid ceramics (Enamic)
and crowns made of PEEK, on the other hand, might meet the
requirements for definitive tooth-colored implant-supported
single-tooth restorations.7,8 Once again, however, insufficient
results from long-term clinical studies are available for these
implant-supported metal-free single-tooth restorations.
Conclusion
On the basis of the data available so far, the following recom-
mendations can be made.
The best evidence currently exists for lithium disilicate and
zirconia ceramics used as metal-free materials for metal-free
implant-supported single-tooth restorations. Internal implant
connections appear to be associated with a higher fracture risk
than external connections in one-piece ceramic abutments.
Among other critical parameters, the restorative vertical height
(RVH) was identified.28 This risk can be circumvented by using
titanium bases in the form of a hybrid abutment plus a separate
crown, or a hybrid abutment crown.21,28,44 Monolithic crowns
made of lithium (di)silicate or zirconia frameworks with a sintered
lithium (di)silicate veneer appear to be suitable as definitive
superstructures. These materials appear to have a failure mode
that protects the implant, as their strength is lower than that of
zirconia.8,15 In the case of solutions that are not screw-retained, a
classic cement (eg, glass-ionomer cement) should be preferred
for the definitive connection of a ceramic crown, as this makes
the removal of excess cement easier.37 Sufficient long-term clini-
cal data are not yet available for polymer-based materials for this
indication. However, preliminary clinical results appear to cast
doubt on the use of CAD/CAM composites for crowns.26
Acknowledgments
The authors thank MDT Evelyn Neubauer, Landshut, Germany,
for the laboratory support in Figures 3a to 3f.
267
 RESTORATIVE DENTISTRY
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Daniel Edelhoff Josef Schweiger Certified Dental Technician, Head of Dental

Laboratory, Department of Prosthetic Dentistry, Munich University
Hospital, LMU Munich, Munich, Germany

Otto Prandtner Master Dental Technician, Plattform Laboratory,

Munich, Germany

Michael Stimmelmayr Associate Professor, Department of Pros-

thetic Dentistry, Munich University Hospital, LMU Munich, Munich,
Germany

Daniel Edelhoff Director and Chair, Department of Prosthetic Jan-Frederik Güth Associate Professor, Department of Prosthetic
Dentistry, Munich University Hospital, LMU Munich, Munich, Dentistry, Munich University Hospital, LMU Munich, Munich,
Germany Germany

Correspondence: Prof Dr Daniel Edelhoff, Department of Prosthetic Dentistry, Munich University Hospital, LMU Munich, Goethestrasse
70, 80336 München, Germany. Email: daniel.edelhoff@med.uni-muenchen.de

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