Page 42 - CEREC Q4 | 2014

40 | CERECDOCTORS.COM | QUARTER 4 | 2014
the profile of most implant
healing caps — even semi-customized
healing caps — differs from the individu-
ally variableprofileof the cervical portion
of the tooth to be replaced by the dental
implant restoration. To optimize esthetic
and functional outcomes in dental
implant therapy, the use of provisional
restorations with ideal emergence profile
contours is recommended to guide and
shape the peri-implant tissues prior to
definitive restoration of the implant.
Provisional restorations are therefore a
crucial aspect of dental implant therapy,
both in esthetic and non-esthetic sites.
The CEREC digital workflow coupled
with the innovative abutment blocks
by Ivoclar Vivadent enable the clini-
cian to provide chairside implant provi-
sional restorations in a very efficient and
predictable manner.
This article will demonstrate how this
workflowcan be utilized to achieve ideal
peri-implant soft tissue contours via two
case examples of immediate implant
placement and immediate implant
provisionalization in the esthetic zone.
CASE EXAMPLE USING IPS E.MAX
HYBRID-ABUTMENT-CROWN BLOCK
This patient is a 26-year-old male who
was referred after a traumatic injury
resulted in a complete horizontal frac-
ture of tooth #9, rendering this tooth
restorativelyhopeless.Theinitialclinical
and periapical radiographic evaluation
revealedahigh lip line, a thinperiodontal
biotype with adequate soft
and hard tissue volume, and
a stabilizing wire bonded
facially onto teeth #6-#11 by
Digital Implant Provisionalization:
The CEREC Advantage
UsingWorkflow to Achieve Ideal Peri-implant Soft-tissue Contures
C A S E S T U D Y | | | B Y FA R H A D E . B O LT C H I , D . M . D . , M . S .
or modified as needed after cone beam
computerized tomographic evaluation
and based on the intraoperative findings.
A cone beam CT radiographic evalu-
ation was performed with the Sirona
Orthophos XG3D CBCT machine and a
digital impression of the patient’s maxil-
lary archwas obtained via scanningwith
the CEREC Omnicam, and the CEREC
Chairside software was utilized to digi-
tallydesign the restoration insite#9. The
CAD/CAM data was then merged with
the CBCT scan in the Anatomage InVivo
implant treatment planning software
and an immediate tapered bone-level
implant was planned in site #9 (Fig. 5).
The treatment planning data was then
sent to Anatomage in California for the
fabrication of a surgical guide.
The surgical procedure was
performed under intravenous conscious
sedation and local anesthesia. In addi-
tion, venous blood was collected and
a centrifuge was utilized to obtain a
Platelet Rich Fibrin (PRF) concentrate.
The Easy X-Trac system (A-Titan)
was utilized to atraumatically extract
the fractured tooth #9 (Fig. 6) and, after
verification of an intact buccal plate,
an immediate implant (Straumann
4.1 x 14 mm SLAtive bone-level implant)
was placed into the extraction socket
#9 via a fully guided flapless approach
(Figs. 7-8). The implant achieved excel-
lent primary stability and was deemed
suitable for immediate non-functional
provisionalization. A bone graft mate-
rial with a slow substitution rate
(Bio-Oss, Geistlich) was then recon-
stituted and mixed with PRF and incre-
mentally packed into the horizontal
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the patient’s restorative dentist (Figs. 1-4).
A preliminary treatment plan was
devised to extract tooth #9 and place an
immediate implant in site #8, coupled
with a simultaneous immediate non-func-
tional provisional implant restoration.
This treatment plan was to be confirmed