A 60-year-old male presented to UT Dental San Antonio pre-doctorate clinic with a chief complaint of sensitivity on a posterior tooth.
Upon examination, it was determined the discomfort was originating from #30, which presented with failing endodontic therapy, core and porcelain-fused-to-metal crown (Fig. 1; all figures in video below).
After presenting various treatment plans to the patient, he opted for an extraction and placement of an implant. Diagnostic impressions were made and he was referred to radiology to obtain a cone-beam computerized tomogram (CBCT).
01 The patient’s CBCT was imported into implant planning software (coDiagnostiX™ by Dental Wings 9.3) for planning and creation of a surgical guide. After fusion of the surface scan, a virtual implant was planned along with a virtual crown and abutment (Figs 2, 3). This allows the restorative team better visualization of the proposed plan and aids in determining whether a screw-retained or cement-retained restoration can be done. It was determined that a flapless surgery technique could be used; therefore, a surgical guide was then designed and sent off for fabrication (Fig. 4).
02 Three months after the extraction and grafting procedure, the primary author performed the surgery using a flapless technique and placed a 4.8x10mm Straumann® SLActive® bone level guided implant (Figs 5,6,7). Since a flap was not reflected, it was decided to obtain an intra-oral scan (3M™ True Definition Scanner) at the time of surgery (Figs 8,9). The case was sent through the 3M™ and Straumann® Trusted Connection workflow from the 3M True Definition into the CARES Visual Design Software, where the dental laboratory fabricated a screw-retained full contour zirconia crown (Straumann® CARES® zerion® HT on a Straumann® Variobase™ abutment) (Fig. 10, Fig. 11).
03 The lab imported the 3M digital file into CARES Visual, designed and ordered the restoration from Straumann, plus a “printed” model from Innovation MediTech. This enabled the technican to insert the Straumann repositionable implant analog into the model socket. The lab delivered the final restoration seated on the model to the restorative doctor in a single shipment. (Fig. 12, Fig. 13.)
04 Approximately two months after surgery, a senior dental student delivered the final restoration with minimal adjustments. (Fig. 14, Fig. 15). The patient was satisfied with the esthetics.
Technology is changing the way treatment is provided to patients, especially in the realm of implant dentistry. The fusion of surface scans with CBCT’s is not new; however, improvement in virtual models provide greater planning tools. Improvements in implant surfaces have decreased the time period between placement and restoration. Intra-oral scanning for an implant restoration is more efficient than a traditional impression and eliminates the need for pouring up of traditional models. The ability to virtually design and mill a final restoration streamlines the laboratory process, resulting in faster turn-around time. The overall result is faster, more efficient treatment of patients with outstanding results.
Disclaimer: the authors would like to thank Dental Services Group and Straumann® for their continuing support of the UT Dental San Antonio pre-doctorate program.
Straumann® Variobase™ Abutment
Part of the Straumann® system, the Variobase™ hybrid abutment provides an excellent restorative option.
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