Copy milling to duplicate the emergence profile for implant-supported restorations

Fully digital workflow for a CAD-CAM custom healing abutment with an optimal emergence profile: A dental technique

The preoperative fabrication of well-contoured, computer-aided design and computer-aided manufacturing (CAD-CAM), custom healing abutments is essential for guiding soft tissue healing and saving chairside time. This dental technique involves a fully digital workflow to fabricate a CAD-CAM custom healing abutment that relies on preoperative digital implant planning. The healing abutment is designed with an optimal emergence profile that can predictably direct the anatomy of the peri-implant mucosa.

Full digital workflow to resolve angled adjacent dental implants: A dental technique

The digital acquisition, fabrication process, and delivery of computer-aided design and computer-aided manufacture (CAD-CAM) implant-supported restorations on angled adjacent implants are described. The proximal surface of a scan post was modified for correct adaptation, permitting an accurate digital scan of adjacent implants in 1 step. Definitive screw-retained splinted implant-supported restorations were designed and milled in a zirconia material and delivered with a combined extraoral and intraoral cementation protocol.

Digital workflow in the design of individualized emergence profiles of implant restorations based on the contralateral tooth

PURPOSE

To describe a novel digital design technique for creating an individualized emergence profile for implant restoration based on the contralateral tooth.

METHODS

Cone beam computed tomography (CBCT) data were used to accurately obtain a three-dimensional (3D) model of the contralateral tooth, which was mirror-flipped to design the emergence profile. The emergence profile was further divided into critical and subcritical areas; the critical area precisely replicated the mirror-flipped 3D model, whereas the subcritical area featured a slight concavity on the buccal side, flatness on the lingual side, and slight convexity on the mesial and distal surfaces. Subsequently, a milling machine was used to fabricate healing abutments with individualized emergence profiles. The design of the definitive restoration completely duplicated the emergence profile of the individualized healing abutment and was fabricated using a milling machine.

CONCLUSIONS

This technical procedure presents an alternative novel method for designing the emergence profiles of implant restorations, with the potential to improve esthetics and functions as well as to maintain the long-term stability of peri-implant soft and hard tissues.

A one-piece CAD-CAM printed custom implant healing abutment: A dental technique

This clinical technique describes a method of fabricating a 1-piece computer-aided design and computer-aided manufacturing (CAD-CAM) printed custom healing abutment. A digital surgical guide and a virtual model based on the proposed implant position were generated. Then, a digitally designed healing abutment was fabricated using the Dental Designer software program. The definitive abutment design was printed from an interim crown resin material. The described method combines the guided implant placement and a 1-piece CAD-CAM printed custom healing abutment to develop appropriate tissue contours.

Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series

OBJECTIVES

The aim of this prospective case series was to assess the implant outcomes as well as hard and soft tissue dimensional changes of immediate implant placement in posterior sites using a custom-made sealing socket abutment (SSA) combined to peri-implant socket filling (PISF).

MATERIAL AND METHODS

Twenty patients were considered for single extraction and immediate implant in upper or lower posterior regions. The remaining peri-implant sockets were filled with Deproteinized Bovine Bone Mineral. Based on intra-oral scans (IOS), custom-made SSAs were placed the same day. Implant survival rate, peri-implant bone changes, peri-implant health and pink esthetic score (PES) were recorded up to 1 year post-implant placement. Moreover, CBCT and IOS were performed to monitor hard and soft tissue dimensional changes.

RESULTS

One implant failed to osseointegrate leading to an implant survival rate of 95% after 1 year. Peri-implant bone changes yielded 0.19 ± 0.31 mm and 84.2% of the implants displayed no or mild bleeding on probing. Horizontal bone remodeling was not significant from baseline to 1 year at any levels. Finally, soft tissue profile was stable in the most cervical area while minor changes occurred during the first 6 months below the gingival margin. The absence of mid-buccal recession (0.07 mm) and good PES were found after 1 year.

CONCLUSION

Despite its limitations, this study showed that immediate implants in the posterior region using the SSA + PISF protocol resulted in promising implant outcomes with limited hard and soft tissue dimensional changes while decreasing the overall treatment time.

Development of Custom Anatomic Healing Abutment Based on Cone-Beam Computer Tomography Measurement on Human Teeth Cross-Section

Introduction: Nowadays, the final success of implantation is not only based on obtaining osseointegration of the implant but is also determined by achieving a satisfactory aesthetic effect of the soft tissues surrounding the implant, which can be defined as an aesthetic integration. The process of obtaining this aesthetic integration already begins at the stage of placing the healing abutment, which allows us to obtain the emergence profile necessary for our prosthetic reconstruction. Materials and Methods: The study used cone-beam computer tomography (CBCT) scans of 51 patients. The measurements of the maxillary teeth (central incisor, lateral incisor, canine, first premolar, and first molar) were performed from cross-sections of the individual teeth at the transition zone to design a custom anatomic healing abutment milled from zirconium and luted to the non-index Ti-base. Results: The obtained results allowed to design and create the shape of the anatomic healing abutment. Conclusions: The use of laboratory-produced anatomical healing abutments is possible and may allow to obtain the desired and planned emergence profiles of prosthetic restorations. In addition, it might be a method of reducing work time at the dental chair but further clinical trials are necessary.

Interdisciplinary guided dentistry, digital quality control, and the "copy-paste" concepts

OBJECTIVE

The aim of this report is to present an interdisciplinary approach with novel concepts to virtually plan and achieve esthetics and function.

CLINICAL CONSIDERATIONS

Despite the advancements in the digital workflow applied to restorative dentistry, the final outcomes are commonly not similar to initial planning. To overcome this major limitation, three concepts are proposed: guided dentistry, digital quality control and "copy-paste" dentistry. Guided dentistry consists of simulations in 3D software and also includes the manufacture of guides/appliances to assist dentists in all clinical steps. Digital quality control involves the use of intraoral scanners and 3D software to compare the real outcomes with the pre-operative simulations after every procedure. "Copy-paste" dentistry is a consequence of the previous two concepts. Using the capacity of the software to overlap files, the original project can be maintained and adapted to achieve results more comparable with the initial design. The proposed method associates facially driven treatment planning and periodontal and restorative procedures to perform the patient's dental rehabilitation.

CONCLUSION

Through a guided workflow and digital control of clinical steps, the final outcomes obtained were equivalent and closer to the initial design.

CLINICAL SIGNIFICANCE

In interdisciplinary cases, the treatment plan needs to address individual requirements and to coordinate sequential clinical stages. It is challenging to meet these demands in a conventional process. The proposed concepts engage technological resources to orientate the procedures and to provide assessment in each step. This approach enables the development of a complete and accurate functional-esthetic rehabilitation. Ultimately, the technique presented is reproducible and the results reflect the established plan.

Immediate implant in the posterior region combined with alveolar ridge preservation and sealing socket abutment: A retrospective 3D radiographic analysis

BACKGROUND

Customized sealing socket abutment (SSA) has been claimed to optimize the peri-implant hard and soft tissues in type 1 implant placement. However, the evidence to claim the benefits of this technique over the use a conventional healing abutment remains weak.

PURPOSE

The aim of this retrospective study was to provide a 3D-radiographic evaluation of hard tissues changes following immediate implant placement in molar sites combined to ARP technique and installation of SSA.

MATERIALS AND METHODS

Baseline and follow-up (FU) CBCTs (from 1 to 5 years) of 26 patients were collected and included in the study. Baseline and FU CBCTs were superimposed and horizontal and vertical bone changes were assessed.

RESULTS

A total of 26 patients and 27 implants were included. Horizontal bone remodeling was not significant in any of the measured areas except in the most cervical level, where a mean bone remodeling of 0.73 mm was found. Proximal and buccal vertical bone changes were not significant.

CONCLUSIONS

Within the limits of a retrospective study, dimensional alveolar ridge changes 1 to 5 years after immediate implant placement in molar sites with simultaneous ARP technique and installation of SSA seem to be very limited.