CATEGORY 70 AUSTRALASIAN DENTIST LINICAL Running away from technology is no longer an option in our dental offices. We must integrate a digital workflow into our daily life, bringing more practicality, maximizing our clinical results, making them more predictable, and bringing more comfort to our patients. Therefore, this case integrates a new methodology of using a custom healing abutment in association with immediate implant placement using the socket shield technique, including the use of a surgical guide for the implant placement to ensure it is installed in the best position considering all the indicated parameters, and a printed custom healing abutment to provide soft tissue healing around the implant for a natural emergence profile for an implantsupported restoration, all digitally planned based on the patient’s CBCT. Planning the case After evaluating all the treatment options, the following was chosen: u PET surgery (Socket Shield) u immediate implant (guided) u healing abutment/temporary u final crown (2nd stage) The case was digitally planned based on the patient’s cone beam computed tomography (CBCT) and an intraoral scan of their maxillary and mandibular arches. The files were imported into a software program (NemoStudio; Nemotec SL). Where was made a 3D segmentation of the tooth to be extracted by manually outlining its area in all CBCT crosssectional images containing the tooth. Then, performed virtual implant planning on the same DICOM images. Based on the desired implant position, a digitally designed surgical guide was made using the dedicated tool of the implant planning software program. Exported the CBCT data, as well as the resulting 3D tooth segmentation and surgical guide as Standard Tessellation Language (STL) files. Then, imported these STL files and the ones from the original intraoral scans into the same CAD software program (DentalCAD; Exocad GmbH) on the same 3D coordinates. In addition, imported the STL files of the implant and Ti-base abutments available from the software library into the same CAD project. Based on the superimposition of the segmented emergence profile, a custom healing abutment was digitally designed to be screwed onto the implant, along with a customized prosthetic abutment and implant-supported crown. Mariana Pozza Alan Costa Digital workflow for 3D-printed custom healing abutment associated with immediate installation of implant using socket shield technique By Alan Costa1, Mariana Pozza2 1. Implantologist, BDS Founder and Director, Digital Dentistry Professor 2. Master in Dentistry, BDS Planner Fig 1. The image shows a fractured crown of a lower molar. Fig 2. Lower CBCT with lips retractor(Dicom Files zip) Fig 3. Intra Oral scanning(STL Files) Fig 4. Three-dimensional positioning of implant (red) based on tooth segmentation (blue-root/ white-crown) Fig 6. Planning the three-dimensional positioning of the implant, to design the surgical guide Fig 5. Printed surgical guide, custom healing abutment and a provisional crown The STL file of the custom healing abutment, and the surgical guide were imported into a slicing software, where they were printed (LCD 3D Printer Slicing Software PiocreatBox; Piocreat). Performed 3D slicing with the parameters indicated by the resin manufacturer.
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