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ePaper created 2017-03-17, 11:21:45 | version 1.38.0
| case report digital workflow Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Figs. 14 & 15: Final computer-aided design of the temporary crown. Fig. 16: Milled restoration in the blank. Fig.17: Provisional crown in place. Fig. 18: Situation after final adjustments with filling material. Fig. 19: Buccal view of the temporary after finishing. DWOS (Dental Wings). Based on this position, the design was created and the emergence profile opti- mised (Fig. 8). This step is optional prior to implant placement, but offers the advantage of a time-saving workflow when the temporary crown is milled for immediate restoration while the patient is still in the chair. Due to the anatomical shape of the patient’s bone, the restoration had to be designed with an incisal screw access hole. Implant placement The implant was placed six week after the emergency treatment and immediately after atraumatic extrac- tion of the root (Figs. 9 & 10) using the prepared guided surgery protocol (Fig. 11). Since slight inaccuracies cannot be avoided in this guided implant surgery process, it was decided to take into account the final implant position for the production of the temporary crown: An intraoral scan was carried out immediately after implant place- ment. For this purpose, a Straumann CARES Mono Scanbody was fixed on the implant (Fig. 12) and some powder applied to it and to the adjacent teeth. Temporisation Finally, the new scan file was imported into the DWOS software (Fig. 13). The predesigned crown was adjusted in a way that it matched the final implant position exactly (Figs. 14 & 15). Thanks to the pre- surgical design step, this procedure took just a few minutes. The temporary crown was milled in the dental office using a hybrid material with tooth-like properties (Fig. 16), luted to a titanium-alloy bonding contact Dr Wiebe Derksen Arnhem, the Netherlands w.derksen@acta.nl 18 CAD/CAM 1 2017 base (Straumann CARES Variobase Abutment), pol- ished and screwed onto the implant in the same ap- pointment for immediate restoration (Fig. 17). The provisional crown was placed slightly out of occlu- sion (without functional loading) to provide for fa- vourable healing conditions. The incisal screw access hole was closed with 3M ESPE Filtek Supreme XTE Universal Restorative (Figs. 18 & 19). The definitive restoration will be cement-retained to avoid the aes- thetic limitations associated with the visibility of the screw hole. Conclusion The present patient case shows that the described combination of digital technologies leads to very good clinical results. The dental practitioner is able to improve the accuracy of implant placement using a guided approach and the precisely fitting temporary restoration is ready to be placed within an hour after completing the surgical procedure. And last, but not least, the patient benefits from increased comfort due to the use of an intraoral scanner and a reduction in the number of required appointments. The proce- dure is currently used for single tooth replacement on a regular basis in our dental office, while we are currently focusing on the development of a workflow for multi-unit restorations as well. The final restora- tions are always produced in a dental laboratory._ References 1 Tahmaseb A, Wismeijer D, Coucke W, Derksen W. Computer technology applications in surgical implant dentistry: a systemat- ic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:25–42. doi: 10.11607/jomi.2014suppl.g1.2.