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    How to create esthetic results using digital dentistry

    Utilizing a digital workflow allows for the best implant position as well as the most optimum esthetics.

    Digital dentistry is changing the way we practice implant dentistry — almost on a daily basis. The days where we brought our patients to surgery and placed the implant “where the bone was” are over. Doctors must now think of the final result first before they even place the implant. This includes not only planning the eventual tooth position, but the surrounding gingival topography as well.

    Through the use of computer planning software, we can now consider the best implant position, which allows the most optimum esthetics. Now, doctors can include sculpting or developing the gingival contour as an integral part of their implant placement. Using a complete digital workflow, these steps are easily achieved to provide our patients with ideal implant placement as well as esthetic restorative considerations.

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    This technique starts with good diagnosis and treatment planning. Beginning with our clinical exam, we design our case with the end result in mind. A well-designed case, along with a well-designed provisional, will not only prepare the emergence profile prior to implant placement but will also assist the implant surgeon in choosing optimal implant position. When a cone beam computed tomography (CBCT) scan and a digital impression of the patient’s existing dentition are obtained, the goal is to create two files: the CBCT, which is a DICOM file, and the intraoral scanner file, which is in a STL format. We then merge those two files in an implant planning software to fabricate our guide and provisional restoration. If teeth are present, we can use these as guides to where we need to place our implants. If teeth are not present, then virtual teeth can be placed into the digital planning software so that implant position can be planned in an ideal location.

    Typically, a surgical guide is printed next and temporary abutment and provisional restoration are milled from these digital files. This allows optimum implant placement as well as esthetic gingival contouring during the healing phase. We are starting to develop the emergence profile of the restoration to mimic that of a natural tooth by developing gingival contours through preplanned and pre-milled provisional restorations or gingival formers; inserted at the time of implant placement.

    Continue to page two to read the case study...

    Dr. Bart Silverman
    Dr. Bart Silverman graduated summa cum laude from Fairleigh Dickinson University in 1982 and received his doctorate in dental medicine ...


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