Page 26 - CEREC Q3 | 2014

24 | CERECDOCTORS.COM | QUARTER 3 | 2014
When you
are in the
smile zone,
most patients
are going to want
some sort of tooth
to be present while
osseointegration of the
implant is occurring.
Most patients are
also going to prefer
a provisional that is
fixed in place and
not removable.
there are many theories
regarding if and when you should
immediately provisionalize implants.
Many factors will play into this deci-
sion, both clinical and patient-based.
If the restoration is in the posterior,
thenmostpatientsanddentistswillbe
fine with placing a healing abutment
(either custom or stock). However,
when you are in the smile zone, most
patients are going to want some sort of
tooth to be present while osseointegration
of the implant is occurring. Most patients
are alsogoing toprefer aprovisional that is
fixed in place and not removable.
In this article, I will be discussing two
different ways to immediately provision-
alize a case depending on the clinical
situation. Both options are fixed in place,
allowing us to correctly form the tissue
profileandaredonedigitallywithCEREC.
CASE STUDY
This patient was treated live at the
Mentor Scientific Symposium at the
Spear Campus inMay 2014 bymyself and
Dr. Farhad Boltchi. She had the primary
right canine (C) extracted, a Straumann
Bone Level implant immediately placed,
PRF and bone grafting completed, and
final implant provisional fabricated. To
watch video of the live surgery, please
visit www.cerecdoctors.com.
The patient presented with a retained
upper-right primary canine. Her chief
complaint revolved around esthetics, and
she stated that she was embarrassed to
smile because of this canine
(Fig. 1). She had some func-
tional wear and eruption
issues that caused some
Immediate Implant
Provisionalization
Two Ways to Correctly Form the Tissue Profile Digitally
CASE STUDY ||| BY MIKE SKRAMSTAD, D.D.S.
result. She declined this treatment at that
time, sowebegantodiscuss implantplace-
ment in the current situation, and possible
long-term risks and complications.
She accepted, consenting to implant
placement in the #6 position. Our first
step was to take a cone beam scan with
the Galileos to both evaluate bone levels
and digitally plan the implant placement
for OptiGuide fabrication. When plan-
ning for the implant placement, a diag-
nostic wax-up was created and dupli-
cated into stone (Fig. 4). This model
was integrated into the cone beam data
to accurately plan implant placement
based on our desired final tooth position.
A wax-up is often beneficial over a
Biogeneric proposal in the edentulous site
becausewewillbeabletouseitthroughout
the restorative process to make design
easier and also guarantee that our restora-
tions (both provisional and final) will not
deviate fromour original plan.
Our initial plan consisted of a bone
gingivalasymmetryandwearfacets(Fig.2).
She also had an extremely tight occlusion
with minimal interocclusal distance in the
area of the primary right canine (Fig. 3).
Our initial recommendation to the
patient was to undergo orthodontic treat-
ment to both level out the gingival zeniths
andmove the teeth in a better position for
a more ideal and predictable long-term
Fig. 1: Pre-op smile
Fig. 2: Gingival asymmetry
Fig. 3: View of occlusion
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