GAP Australasian-Dentist-Mar Apr 2019

Category 58 AustrAlAsiAn Dentist Abstract Predictability and efficiency in implant dentistry are the goals of clinicians and patients when dealing with a problem in the aesthetic zone. the immediate smile protocol, a prosthetically generated plan, allows for the simplified planning and execution of implant placement and provisionalization. this protocol allows for the design and utilization of a simplant sAFe Guide, an Atlantis patient- specific abutment, and a provisional to be manufactured prior to the surgical visit allowing for maximum precision and efficiency during that visit. Patients and clinicians are challenged with a multitude of clinical decisions when faced with a failing tooth in the aesthetic zone. should the tooth be extracted and grafted? should immediate implant therapy be considered? if so, how will temporization be accomplished? these scenarios are compounded by the sense of urgency typically demonstrated by the patients facing this challenge. they want the treatment to be accomplished in the most expedited manner available to help alleviate any further embarrassment due to the loss of an anterior tooth. thankfully, modern implant dentistry can fulfill these needs. immediate implant placement and provisionalization are routinely utilized to help address these issues. immediate placement involves the instillation of the implant into a fresh extraction socket, 1 which has been associated with high implant success rates, 2 similar to those attained with conventional placement. 3,4 Attaining adequate initial stability above 25 ncm allows for immediate provision- alization. 5 this has been linked with im- proved esthetics in the anterior region, 6 better soft tissue stability, 7 and decreased resorption of the facial cortical bone. 8 When both immediate placement and im- mediate provisionalization protocols are utilized, the patient is able to leave the office feeling comfortable and confident having a fixed anterior interim prosthesis. With the leveraging of dental technology in these areas, the precision and productivity of immediate placement and loading also has increased. 9 Guided implant surgery with simplant (Dentsply sirona implants, dentsplyimplants.com) , allows for very precise, prosthetically driven implant planning. 10 the clinician is able to visualize the cementoenamel junction and the incisal edge of the proposed tooth and plan the final implant relative to these areas to help ensure soft tissue stability and an esthetic outcome. 11 technology can be further utilized to design and manufacture a custom abutment and provisional or final restorations. the protocol for immediate smile featuring Atlantis abutments utilizes all of these planning and manufacturing tools to simplify the clinical visit. it begins with the registration of the patient’s pre- operative condition and final restorative plan via digitized casts (or intraoral scans) and merges them with the bony conditions of the patient from their cone- beam computed tomography (CBCt) scan. the implant is planned and the simplant project file is sent to Dentsply sirona implants for patient-specific sAFe Guide and Atlantis abutment design. the final plan for the custom abutment is then exported to any dental laboratory software for the design of the provisional or final restoration. the surgical guide, custom abutment, and restoration are then manufactured and returned to the clinician, allowing for efficient implant placement and provisionalization. Case presentation A 62-year-old woman presented on emergency, reporting having fractured her right central incisor (Figure 1). the area was asymptomatic and demonstrated no problems other than the embarrassment associated with the loss of her front tooth. Diagnostic records were made and an essix retainer (essix.com) was fabricated to help alleviate her immediate esthetic concerns. Due to the lack of tooth structure incisal to the gingiva, the prognosis of the tooth was very guarded. Various options to restore this area were presented to the patient, leading to her ultimate choice of a dental implant. A diagnostic CBCt scan of the patient was attained and the patient left the office wearing the retainer. From this emergency/diagnostic visit, Replicating nature with the immediate smile protocol By Mark Ludlow, DMD, Ms, inside Dental technology lInICal Figure 1 Figure 2 all relevant information was gathered to plan her treatment. the diagnostic stone casts were digitized and a digital waxup achieved in the Dental Designer CAD software, (3shape, 3shape.com ) (Figure 2). this single tooth was milled out of wax, fixed to the pre-operative cast, and digi- tized. the digital files were then exported in an stl file format. they were then uploaded into simplant planning software. the DiCOM file obtained from the CBCt scan of the patient was also uploaded and all three files were merged to accurately express the pre-operative situation, pro- posed final tooth position, and the ana- tomical features of the future implant site. With all of this needed information relative to the pre-operative condition and proposed final tooth position, the treatment moved into the assessment and planning phase. the CBCt revealed an intact buccal plate anterior to the root of tooth no. 8 with adequate bone surrounding the area in all dimensions. Because of the favourable bony contours, an immediately placed implant was decided upon and planned in the software. the CeJ of the proposed final tooth location was identified and an Osseospeed eV 4.2 C – 11 mm implant (Dentsply implants) was planned 3 mm apical and 2 mm lingual to that landmark 12 to assure adequate biologic and prosthetic space for the final restoration (Figure 3 through Figure 5). A simplant sAFe Guide was selected and ordered to convey all of the positional parameters of the final