Pilot Guided implant Placement and Chairside CAD/CAM Implant provisional in the Esthetic Zone

Wael F. Isleem

Julian Conejo

Howard Fraiman

Rodrigo Neiva

Isleem, Wael F.¹, Conejo, Julian², Fraiman, Howard¹, Neiva, Rodrigo¹
¹University of Pennsylvania School of Dental Medicine, Department of Periodontics
²University of Pennsylvania School of Dental Medicine, Department of Preventive and Restorative Sciences

Introduction

Digital dentistry has taken dental implantology to a new level. The evolution of cone beam tomography, computer assisted designing, computer assisted manufacturing and additive manufacturing contributed to this revolution. The dental implant is one of the first treatment options in replacing missing teeth. However, placing implants in the esthetic zone is still considered a challenge. Immediate provisionalization increases patient satisfaction, preserves gingival architecture around the implants and decrease overall duration of treatment. Chair-side CAD/CAM systems facilitate the immediate provisionalization of implants in the esthetic zone.

Methods

A 36 old female patient presented to Penn Dental Medicine Periodontal Prosthesis clinic for comprehensive exam. After clinical and radiographic examination. A comprehensive treatment plan created including treatment of missing tooth # 5. Multiple treatment options were offered to the patient. The patient elected implant supported fixed restorations. CBCT and pre operation intra oral scan taken. pilot surgical guide was designed and milled using the data collected. Implant was placed following osteotomy preparation protocol. Placement torque was >35 ncm. Scan body was used to take intra oral scan of the implant timing and position. PMMA crown was milled and cemented to titanium base extra orally. Crown was delivered. occlusion was checked to make sure no centric or eccentric occlusion. The digital planning enhanced the final results in terms of correct implant depth to create appropriate emergence profile and achieve gingival margins that matches contralateral tooth.

Results

Digital planning facilitated the fabrication of implant provisional restorations chair-side in one visit that matches prospective final restoration. This approach optimized restorative driven implant placement.

Conclusion