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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.


    Case study

    A 61-year-old male presented to my office with a fractured maxillary left canine. His past medical history was significant for previous DVT for which he was taking Coumadin. He has no known allergies (Fig. 1).

    Fiig. 1Fig. 2

    Fig. 1                                                                                                Fig. 2

    A CBCT scan was taken with a Carestream Dental CS 9300 (Figs. 2 and 3) and an intraoral scan was obtained using a Carestream Dental intraoral scanner (Figs. 4 and 5).

    Fig. 3Fig. 4

    Fig. 3                                                                                             Fig. 4

    In this case, one file was sent to Roe Dental Labs in Ohio for fabrication of the surgical guide and another file was sent to Vulcan Dental Labs in Alabama for fabrication of a temporary restoration. The exactness of the digital technology allowed for this degree of specificity whereby both the guide and the temporary fit together as if they were made at the same lab (Figs. 6 and 7).

    Fig. 5Fig. 6

    Fig. 5                                                                                             Fig. 6

    The patient was taken to the oral surgicenter where, under intravenous sedation, the maxillary left canine was surgically removed using appropriate periotomes and elevators. The tooth-borne surgical guide was placed (Fig. 8) and, using the Biohorizons Guided Surgical protocol, the Biohorizons Tapered Internal 4.6mm x12mm immediate implant was placed (Fig. 9). Ostell reading of 68 confirmed sufficient initial stability to provide an immediate load.

    Fig. 7Fig. 8

    Fig. 7                                                                                              Fig. 8

    The Biohorizons custom milled temporary abutment and temporary custom PEEK crown were placed (Fig. 10). The gap between the implant and the extraction socket grafted with MinerOss, the occlusion adjusted and the soft tissue closed starting to contour the gingival tissues immediately.

    Fig. 9Fig. 10

                                    Fig. 9                                                                                             Fig. 10

    This technique utilizes a digital workflow to provide initial implant planning, placement and esthetic sculpting of the gingival tissues. It affords the ability to start contouring an ideal emergence profile at the time of implant placement (Fig. 11).

    Fig. 11

    Fig. 11

    The provisional crown will be in place for three months and, following Ostell testing again, a final restoration affording optimum tissue contour will be fabricated.

    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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