By Yao-Lin Tang, DDS

An emergency patient was referred with a broken tooth No. 9. It had previously been treated with a root canal and crown, but the tooth had fractured. Because the patient lives about an hour and a half from my office, I decided to do an immediate implant with guided surgery. The Orthophos XG 3D CBCT unit and the CEREC Omnicam (both Dentsply Sirona) were used to capture an intraoral scan of her upper arch. Next the restoration for tooth No. 9 was designed using CEREC software. An SSI file was exported and imported into the Galaxis CBCT software, merging both files. This data was used to determine the best angulation for the implant, the appropriate implant crown position, and the bone condition.

The patient’s buccal plate is very thin. The ridge is very limited, and it would be very challenging to attempt to do an immediate implant procedure on this patient without the accuracy of a surgical guide. CEREC software was used to design a CEREC Guide 2, which was then milled with the CEREC MC XL milling machine. This process takes about 30 to 40 minutes.

Tooth No. 9 was extracted atraumatically with a Benex Extractor (Benex Dent), preserving all the bone. After placing the CEREC Guide 2, the osteotomy was performed through the surgical guide. Next, the 3.3 x 12 mm implant (Straumann) was placed, a bone graft was added, and a cover screw was used to cover it to enhance healing. In order to maintain the gingival papilla, I used the CEREC to make a temporary cantilever bridge with an ovate contact on tooth No. 9 out of CERASMART (GC America). The temporary restoration was cemented using tooth No. 10 (which also needs a crown) as the abutment for the cantilever bridge. Although this was a temporary, I make temporaries with CEREC just like a permanent restoration, and I custom stain and glaze both temporary and final restorations.

The patient returned after 2 weeks for a postop check, at which point the site was healing very well. When the patient returned again in 4 months, I exposed the implant, and the CEREC was used to mill a VITA ENAMIC IS custom abutment (VITA North America) to train the gingival tissue for the final restorations. The patient returned in another 2 weeks for the final restoration. I used the CEREC and VITA ENAMIC IS as the abutment material for tooth No. 9 and for both final crowns.