Definitive Presurgical CAD/CAM-Guided Implant-Supported Crown in an Esthetic Area

Abstract

This paper describes the digital workflow from cone beam computer tomography (CBCT) to the installation of a definitive presurgical zirconium individual crown in a 19-year-old woman requiring implant replacement of a maxillary right lateral incisor. The patient had agenesis of this tooth and had completed the orthodontic treatment. CBCT was conducted and diagnostic casts were digitized. Virtual planning was completed by defining a prosthetically driven implant and a stereolithographic surgical template was produced. Good adaptation of a stereolithographic surgical template was verified in the working cast. Implant and abutment were installed in this cast using a stereolithographic surgical template, and a CAD/CAM definitive zirconium crown was produced. Flapless computer-guided implant surgery was performed. The abutment was connected, and a definitive zirconium crown was cemented using resin cement. The digital workflow presented herein shows high accuracy for a virtually planned implant with flapless guided placement, allowing the successful delivery of a definitive presurgical zirconium single crown in an esthetic area in a single visit. The patient was revaluated after 1 year of function with an excellent outcome of the treatment.

Clinical Evaluation of Full Digital Workflow to Provide a Prefabricated Immediate Restoration After Single-Implant Placement

“…The first factor is the accuracy of transferring the virtual implant planning to the cast on which the immediate restoration will be made. Compared to the other techniques (7,8) , this factor was well controlled in the presented digital workflow as the virtual implant planning was transferred to the prosthesis-designing software using a virtual scan body which was accurately positioned by the implant-planning software. Consequently, the process was not affected by the errors resulting from technician skills or dimensional changes accompanying physical casts.…”

“…Immediate loading protocol can guide the healing of the peri-implant soft tissues and eliminate second-stage surgery (1) . Immediate implant-supported restorations can be fabricated using different prosthetic techniques which are based on either clinical relining of prefabricated shells (2)(3)(4)(5)(6) , adjusting prefabricated restorations (7)(8)(9)(10)(11) or delivering postoperatively fabricated restorations (12,13) . The current techniques made use of the technologies of Computer-Aided Design/ Computer-Aided Manufacturing (CAD/CAM) and digital dentistry.…”

“…The accuracy of prefabricated restorations has been increased with the integration of CAD/CAM technology into implant treatment and evolution of full guided implant surgeries. The clinical accuracy of the prefabricated restorations is based on the accurate transfer of virtual implant planning to a cast for constructing the immediate restoration and the accuracy of the fully guided surgical template to transfer the virtual planning to the patient mouth (7,8) . Transferring the virtual implant planning for constructing the restoration can be accomplished by placing implant analogues into a cast that is either printed according to the implant planning (7) or poured using a fully guided surgical template (8) .…”

“…The clinical accuracy of the prefabricated restorations is based on the accurate transfer of virtual implant planning to a cast for constructing the immediate restoration and the accuracy of the fully guided surgical template to transfer the virtual planning to the patient mouth (7,8) . Transferring the virtual implant planning for constructing the restoration can be accomplished by placing implant analogues into a cast that is either printed according to the implant planning (7) or poured using a fully guided surgical template (8) . Presence of many laboratory procedures that can affect the accuracy of the delivered restorations has aroused the need for a more precise and faster technique.…”