CASE PRESENTATION
Leveraging Digital Technology
in Implant Dentistry
The world is going digital and getting more efficient. Dentistry is no different! Too often, we believe that technology and efficiency cost more money and deliver less than ideal results. This simply isn’t true. To better illustrate my perspective, let’s take a look at a recent implant case from start to finish.
A woman comes to our office with pain around her upper right molar. After accessing the pulp, it is discovered that the tooth is nonrestorable because of a vertical root fracture (Figure 1). Traditional implant therapy would take 9 to 12 months for completion, involve at least 6 to 9 patient visits, and use about 4 hours of chair time. By leveraging digital technology, we can complete treatment in approximately 4 months, only 3 patient visits, and achieve an excellent result in about 2 hours of chair time.
Visit 1
At the first visit, when we determined that endodontic therapy was no longer an option, we took records that involved a digital impression with CEREC and a 3D CBCT with ORTHOPHOS SL (Dentsply Sirona). The planning confirmed that immediate placement was possible (Figures 2A and 2B).
I have found CBCT and guided surgery to be immensely helpful in increasing the number of cases that are candidates for immediate placement—placing the implant at the same time as extraction. Having a surgical guide allows you to place an implant with precision and maximize the remaining bone for implant stability.
Through the combination of the CEREC Omnicam digital impression and the virtual implant planning (Figure 3), we are able to order and/or mill in-office our surgical guide.
Visit 2
With immediate placement, it is critically important to use atraumatic extraction technique to preserve the bony plates and interseptal bone (Figures 4 and 5). When the tooth is removed and the sockets thoroughly cleaned, the osteotomy is completed with the guide in place. This ensures proper trajectory, depth, and bone engagement. The implant is then also placed through the surgical guide (Figures 6 and 7). The “gap” is grafted with your bone of choice and the site is closed to allow tissue healing and implant integration.
Visit 3
After an adequate integration period of 4 months in immediate placement, the patient is ready for restoration. Using CEREC, we are able to actually take a digital impression at the time of uncovering (Figure 8). The final implant restoration is designed immediately, giving the dentist complete control over all aspects of restoration emergence, tissue support, occlusal scheme, and esthetics (Figure 9).
The dental assistant will then crystallize, stain, and glaze the restoration. We actually like to combine the recall visit with implant delivery (Figure 10). The final screw-retained implant restoration (e.max abutment block, Ivoclar Vivadent) is inserted and the access covered with direct resin (TetricCeram, Ivoclar Vivadent) (Figure 11).
Here you can see radiographs of each step— immediate placement, digital impression post, and final restoration delivery (Figure 12). The final result is well-preserved bone, ideally supported tissue, and esthetic implant restoration in just 3 patient visits. The result is a win-win for the patient and practice.
GO-TO PRODUCTS USED IN THIS CASE
CEREC OMNICAM - https://www.dentalproductshopper.com/cerec-omnicam
ORTHOPHOS SL - https://www.dentalproductshopper.com/orthophos-sl
