Clinical Case
Burbank Dental Lab was fortunate to work with Dr. Daniel Domingue on the following implant case. The patient presented with an unsavable upper lateral. She was leaving town and needed to leave with a tooth. After examination, it was determined that she was a good candidate for immediate implant placement.
The patient was sedated, and the tooth was extracted (see above image). An immediate implant was placed.
The implant used was a 3.5 x 13 MegaGen Anyridge implant.
An immediate temporary was placed on a PEEK abutment. The patient was able to leave town with a functioning temporary in place.
Digital Workflow
This case was scanned using a digital scanner (3Shape). Digital impressions create improved workflows in single-unit implant cases.
This patient needed to have the final abutment and crown finished in 7 days. Digital workflows help to improve turnaround times and provide this patient with the timeline she required. In addition, intraoral scanners also provide the following benefits:
- Digital impressions remove the potential of gagging and taste issues often associated with traditional impressions.
- Improved accuracy as digital impressions reduce opportunities for error.
- Reduced overhead by eliminating impression-taking materials.
- Improved turnaround times as the need to ship the impressions to the lab is eliminated.
- Digital impressions are captured faster than traditional methods, improving practice efficiency.
- Reduced occurrence of remakes as the data can be shared and discussed in real-time. Potential problems are found before cases are fabricated.
The implant was given time to integrate. The patient returned after three months for the final restoration. The patient was scanned using a scan body to capture the specific implant information. In addition to the scan body, an opposing and bite record are also recorded. The data was viewed as a 3-dimensional model on a screen. The scan was evaluated to ensure the necessary information was captured.
The digital file was uploaded to Burbank Dental Lab. In addition, detailed information such as implant information, desired abutment specifications, esthetic concerns, crown material, and any other information could be provided to ensure the case is successful at the seat appointment. A Burbank Dental Lab implant team member can help with the steps above or answer any questions to help ensure a successful output.
Design and Manufacture
Burbank Dental Lab received the digital files and began the process of design. The files were evaluated to ensure no issues were present. A SMART 1 Zirconia Abutment was designed and milled with a layered zirconia crown to match the surrounding dentition.
Accuracy in these types of cases relies on the precision of the equipment being used to both design and mill the final output. At Burbank Dental Lab, the milling is done using CNC (computer numerical control) milling machines that produce a high level of accuracy. This is crucial in the customization of not only margins and contacts for crowns but also crucial for customized implant abutments.
SMART 1 Abutments
Once the abutment was designed and milled, the final restoration was then completed (fig 3). It was determined that a layered ZIRMAX Zirconia crown would be necessary to blend and match the surrounding dentition. Once completed, the case was sent to Dr. Daniel J. Domingue for insertion.
Use the following protocol when delivering SMART 1 zirconia abutments:
- Use a torque wrench to tighten the abutment within the implant manufacturer’s guidelines. This is usually between 15Ncm to 35Ncm.
- The abutment screw hole can be closed with PTFE tape (Teflon). This tape does not pick up odors and can be sterilized.
- For cementation, place a ring of cement 1-2 mm for the margin. Permanent cement is not recommended.
This restoration option created an excellent result that was natural and met the patient’s esthetic concerns (see above image). The implant immediate load protocol was a perfect treatment option for this patient as it met her timing demands as well.
Being able to offer a solution for patients who travel a lot and need an option when it comes to implant treatments is invaluable. This patient had her needs met and left the appointment a fan.
