Immediate Implant Placement of a Single Central Incisor Using a CAD/CAM Crown‐Root Form Technique: Provisional to Final Restoration

OBJECTIVE Preserving soft and hard tissues after extraction and implant placement is crucial for anterior esthetics. This technique will show how the information gathered from a cone-beam computed tomography (CBCT) scan of the maxillary left central incisor and an intra-oral digital impression can be merged to fabricate a CAD/CAM crown-root matrix to be used as an immediate provisional restoration that mimics the natural anatomy. CLINICAL CONSIDERATIONS Due to trauma, a left central incisor appeared to be fractured and was scheduled for extraction and implant placement. The crown-root configuration captured by the CBCT scan was merged with the digital files from an intra-oral digital impression. A CAD/CAM crown-root matrix was fabricated. Because the matrix shell was fabricated with the exact anatomy of the natural tooth, it replicated the position and three dimensional anatomy of the soft and hard tissue. It was connected to the implant with a customized provisional abutment. A digital impression of a coded healing abutment was made to fabricate the final implant abutment and final restoration. Throughout the treatment time and 36 months after completion, the thickness of tissue, emergence profile, and adjacent papilla was analyzed by clinical evaluation and photography and seemed to be maintained. CONCLUSION The use of a pre-operative intra-oral digital scan of the clinical crown-root architecture and the CBCT scan of the bone/root anatomy, can be used together to fabricate a CAD/CAM crown-root form provisional matrix. This digital design helps in the preservation of the 3D tissue topography, as well as the final restoration. CLINICAL SIGNIFICANCE The preservation of soft and hard tissue after extraction and implant placement has always been paramount for ideal anterior implant esthetics. Using the information from digital files from CBCT scans and intra-oral scans may help the clinician identify critical anatomical features that can be replicated in the provisional and final CAD/CAM restoration. (J Esthet Restor Dent 29:13-21, 2017).

[1]  J. Liu,et al.  Immediate provisional for single-tooth implant replacement with Brånemark system: preliminary report. , 2001, Clinical implant dentistry and related research.

[2]  Albert Mehl,et al.  A 3-dimensional accuracy analysis of chairside CAD/CAM milling processes. , 2014, The Journal of prosthetic dentistry.

[3]  D. Tarnow,et al.  Human histologic verification of osseointegration of an immediate implant placed into a fresh extraction socket with excessive gap distance without primary flap closure, graft, or membrane: a case report. , 2011, The International journal of periodontics & restorative dentistry.

[4]  U. Belser,et al.  Thickness of the anterior maxillary facial bone wall-a retrospective radiographic study using cone beam computed tomography. , 2011, The International journal of periodontics & restorative dentistry.

[5]  J. Rubenstein,et al.  Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement. , 1997, The International journal of oral & maxillofacial implants.

[6]  K. Rungcharassaeng,et al.  Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale. , 2000, Practical periodontics and aesthetic dentistry : PPAD.

[7]  R. Lazzara,et al.  A simplified impression protocol for fabrication of anatomical, cement-retained CAD/CAM abutments. , 2014, The International journal of periodontics & restorative dentistry.

[8]  R. Haas,et al.  Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. , 2005, Clinical oral implants research.

[9]  H. De Bruyn,et al.  Comparison of radiographic and clinical outcomes following immediate provisionalization of single-tooth dental implants placed in healed alveolar ridges and extraction sockets. , 2010, The International journal of oral & maxillofacial implants.

[10]  D P Tarnow,et al.  Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1- to 5-year data. , 1997, The International journal of oral & maxillofacial implants.

[11]  Kitichai Rungcharassaeng,et al.  Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. , 2003, The International journal of oral & maxillofacial implants.

[12]  Wöhrle Ps,et al.  Single-tooth replacement in the aesthetic zone with immediate provisionalization: fourteen consecutive case reports. , 1998 .

[13]  J. Caruso,et al.  Maxillary Central Incisor-Incisive Canal Relationship: A Cone Beam Computed Tomography Study , 2012 .

[14]  P. Hardigan,et al.  Gingival margin changes in maxillary anterior sites after single immediate implant placement and provisionalization: a 5-year retrospective study of 47 patients. , 2014, The International journal of oral & maxillofacial implants.

[15]  J. Wennström,et al.  Implant supported single-tooth replacements compared to contralateral natural teeth. Crown and soft tissue dimensions. , 1999, Clinical oral implants research.

[16]  J. Cosyn,et al.  Single-tooth replacement in the anterior maxilla by means of immediate implantation and provisionalization: a review. , 2008, The International journal of oral & maxillofacial implants.

[17]  D. Tarnow,et al.  The dual-zone therapeutic concept of managing immediate implant placement and provisional restoration in anterior extraction sockets. , 2012, Compendium of continuing education in dentistry.

[18]  M. Bertolini,et al.  The use of CAD/CAM technology to fabricate a custom ceramic implant abutment: a clinical report. , 2014, The Journal of prosthetic dentistry (Print).

[19]  Periklis Proussaefs,et al.  Immediate provisionalization with a CAD/CAM interim abutment and crown: a guided soft tissue healing technique. , 2015, The Journal of prosthetic dentistry.

[20]  Kitichai Rungcharassaeng,et al.  Gingival biotype assessment in the esthetic zone: visual versus direct measurement. , 2010, The International journal of periodontics & restorative dentistry.

[21]  W. Edgin,et al.  Preservation of soft tissue contours with immediate screw-retained provisional implant crown. , 2007, The Journal of prosthetic dentistry.

[22]  Daniel Buser,et al.  Clinical and esthetic outcomes of implants placed in postextraction sites. , 2009, The International journal of oral & maxillofacial implants.

[23]  N. Lang,et al.  A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. , 2010, Clinical oral implants research.

[24]  Eriberto Bressan,et al.  Virtual abutment design: a concept for delivery of CAD/CAM customized abutments-- report of a retrospective cohort. , 2013, The International journal of periodontics & restorative dentistry.

[25]  Sang-Choon Cho,et al.  Accurate transfer of peri-implant soft tissue emergence profile from the provisional crown to the final prosthesis using an emergence profile cast. , 2007, Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.].

[26]  P. Kamposiora,et al.  Presentation of two cases of immediate restoration of implants in the esthetic region, using facilitate software and guides with stereolithographic model surgery prior to patient surgery. , 2011, Journal of prosthodontics : official journal of the American College of Prosthodontists.

[27]  John Kim,et al.  Finding Z: a mathematical method for predicting tissue position after implant abutment-restoration placement. , 2014, The Journal of prosthetic dentistry.

[28]  M. Block,et al.  Prospective evaluation of immediate and delayed provisional single tooth restorations. , 2009, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[29]  D. Tarnow,et al.  Managing esthetic challenges with anterior implants. Part 1: midfacial recession defects from etiology to resolution. , 2013, Compendium of continuing education in dentistry.

[30]  D. Tarnow,et al.  Subclassification and Clinical Management of Extraction Sockets with Labial Dentoalveolar Dehiscence Defects. , 2015, Compendium of continuing education in dentistry.

[31]  F. Bajoghli,et al.  Evaluation of the three-dimensional accuracy of implant impression techniques in two simulated clinical conditions by optical scanning. , 2015, The International journal of oral & maxillofacial implants.

[32]  Yoav Grossmann,et al.  A novel technique using a coded healing abutment for the fabrication of a CAD/CAM titanium abutment for an implant-supported restoration. , 2006, The Journal of prosthetic dentistry.

[33]  J. Lozada,et al.  Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year follow-up. , 2011, The International journal of oral & maxillofacial implants.

[35]  Adam J. Mieleszko,et al.  A novel prosthetic device and method for guided tissue preservation of immediate postextraction socket implants. , 2014, The International journal of periodontics & restorative dentistry.

[36]  H. Haanaes,et al.  Immediate loading of single-tooth ITI implants in the anterior maxilla: a prospective 5-year pilot study. , 2002, Clinical oral implants research.