Figure 2: With good overall dental health, no periodontal involvement, and pink, stippled soft tissue, implant treatment was an excellent option for replacing the maxillary lateral incisor.

Figure 3: Radiographic view of the retained primary tooth. Although most of the root structure had vanished over time, favorable bone volume was present apical to the tooth. Tooth extraction followed by immediate placement of a dental implant was proposed to the patient, who was young and wanted to avoid preparation of the healthy adjacent teeth to support a fixed bridge. The patient accepted the treatment plan and agreed to return two weeks later for the surgical appointment.

Figure 4: CBCT analysis confirmed adequate vertical and horizontal bone volume for a dental implant immediately following extraction, without the need for bone grafting. Guided surgery was selected to minimize the invasiveness of the procedure. Further, the patient’s adequate attached tissue was ideal for flapless surgery, and the tooth’s location in the esthetic zone called for a higher degree of precision and predictability to ensure the best possible esthetic outcome.

Figure 5: Full-arch scans were taken with a TRIOS^® intraoral scanner (3Shape North America; Warren, N.J.). To initiate a case for the Hahn Guided Surgery System, either a highly accurate vinyl polysiloxane (VPS) impression or a full-arch digital impression is acceptable. The impression is submitted along with the CBCT scan and instructions for the digital treatment plan to the surgical guide manufacturer. In this case, a digital wax-up of the tooth was requested, as well as implant positioning that would facilitate a screw-retained crown. Additionally, an immediate provisional crown was prescribed for delivery at the time of surgery.

Figures 6a, 6b: After receiving the intraoral and CBCT scans, the Digital Treatment Planning (DTP) department at Glidewell Laboratories merged the data to create a virtual 3D model of the patient’s mouth, dentition, hard- and soft-tissue contours, and underlying anatomy. The DTP team proposed a digital treatment plan, including proper implant positioning for the desired method of screw-retention and an optimal emergence profile in the esthetic zone. Note that Hahn Tapered Implants can be placed using surgical guides from several guided surgery service providers.

Figures 6a, 6b: After receiving the intraoral and CBCT scans, the Digital Treatment Planning (DTP) department at Glidewell Laboratories merged the data to create a virtual 3D model of the patient’s mouth, dentition, hard- and soft-tissue contours, and underlying anatomy. The DTP team proposed a digital treatment plan, including proper implant positioning for the desired method of screw-retention and an optimal emergence profile in the esthetic zone. Note that Hahn Tapered Implants can be placed using surgical guides from several guided surgery service providers.

Figure 7: The DTP team created the surgical guide design to precisely control the implant position at a distance of 2 mm from the neighboring teeth and 2.5 mm below the adjacent CEJ. The digital treatment plan and surgical guide design were sent for doctor review and were approved without the need for any modifications.

Figures 8a, 8b: A tooth-supported surgical guide was fabricated to precisely control the depth, angulation, and mesial-distal and buccal-lingual location of the implant osteotomy in accordance with the approved digital treatment plan. The titanium sleeve was secured within the surgical guide. Note that the Hahn Tapered Implant Guided Surgery System does not require drill keys, as the surgical kit includes diameter-specific drills for each available implant size.

Figures 8a, 8b: A tooth-supported surgical guide was fabricated to precisely control the depth, angulation, and mesial-distal and buccal-lingual location of the implant osteotomy in accordance with the approved digital treatment plan. The titanium sleeve was secured within the surgical guide. Note that the Hahn Tapered Implant Guided Surgery System does not require drill keys, as the surgical kit includes diameter-specific drills for each available implant size.

Figure 9: An immediate screw-retained BioTemps^® Provisionals crown (Glidewell Laboratories; Newport Beach, Calif.) was designed and fabricated in advance of the surgical appointment based on the digitally determined implant position, providing a temporary restoration to contour the soft tissue, interdental papillae and emergence profile during the healing phase for an ideal prosthetic outcome.

Figures 10a, 10b: At the surgical appointment, after tracing around the circumference of the crown with a microblade to separate the tooth from the periodontal ligament, the deciduous tooth was elevated using periosteal elevators.

Figures 10a, 10b: At the surgical appointment, after tracing around the circumference of the crown with a microblade to separate the tooth from the periodontal ligament, the deciduous tooth was elevated using periosteal elevators.

Figures 11a–11c: After extracting the tooth, the surgical guide was tried-in and exhibited a precise fit. Note the window of the surgical guide (11c), which is incorporated in the design to ease verification of full seating of the guide against the teeth.

Figures 11a–11c: After extracting the tooth, the surgical guide was tried-in and exhibited a precise fit. Note the window of the surgical guide (11c), which is incorporated in the design to ease verification of full seating of the guide against the teeth.

Figures 11a–11c: After extracting the tooth, the surgical guide was tried-in and exhibited a precise fit. Note the window of the surgical guide (11c), which is incorporated in the design to ease verification of full seating of the guide against the teeth.

Figure 12: The implant osteotomy was created using the Hahn Guided Surgical Kit, which includes an easy-to-follow drill sequence, color-coded instrumentation, and diameter-specific drills with built-in depth stops.

Figures 13a, 13b: The implant osteotomy was created using the Hahn Guided Surgery System, following a streamlined surgical protocol. After using the alignment and pilot drills to initiate the proper location and trajectory of the osteotomy, the shaping drills were utilized to establish the precise diameter and length of the prescribed 3.5 mm x 13 mm Hahn Tapered Implant.

Figures 13a, 13b: The implant osteotomy was created using the Hahn Guided Surgery System, following a streamlined surgical protocol. After using the alignment and pilot drills to initiate the proper location and trajectory of the osteotomy, the shaping drills were utilized to establish the precise diameter and length of the prescribed 3.5 mm x 13 mm Hahn Tapered Implant.

Figure 14: After flushing the site with sterile water to ensure the osteotomy was free of bone debris, the implant was placed directly through the guide utilizing a torque wrench.

Figure 15: With the implant fully seated, the hex flange of the implant mount was flush with the hex of the guide sleeve. This confirmed proper orientation of the implant platform, which was important for proper fit and alignment of the BioTemps screw-retained crown and, eventually, the final restoration.

Figures 16a, 16b: Postoperative occlusal and radiographic views show the implant in the exact position determined by the digital treatment plan. The deep, sharp threads of the Hahn Tapered Implant helped establish the high primary stability that is essential for immediate placement cases and necessary for immediate provisionalization.

Figures 16a, 16b: Postoperative occlusal and radiographic views show the implant in the exact position determined by the digital treatment plan. The deep, sharp threads of the Hahn Tapered Implant helped establish the high primary stability that is essential for immediate placement cases and necessary for immediate provisionalization.

Figures 17a, 17b: The BioTemps screw-retained crown was delivered using a hand driver. Because the temporary crown was fabricated based on the digitally determined implant position, the BioTemps provisional exhibited a precise fit.

Figures 17a, 17b: The BioTemps screw-retained crown was delivered using a hand driver. Because the temporary crown was fabricated based on the digitally determined implant position, the BioTemps provisional exhibited a precise fit.

Figures 18a, 18b: The occlusion of the BioTemps provisional was checked, and slight alterations were made to the crown contours for esthetics and to avoid occlusal contact during function. The patient was very pleased with the esthetics of the delivered BioTemps crown.

Figures 18a, 18b: The occlusion of the BioTemps provisional was checked, and slight alterations were made to the crown contours for esthetics and to avoid occlusal contact during function. The patient was very pleased with the esthetics of the delivered BioTemps crown.

Figure 19: At the one-month follow-up appointment, the patient had healed well. Facial view shows emergence profile and interproximal papilla development fostered by the provisional crown. Oral hygiene habits were encouraged for the patient to address the slight inflammation of the soft tissue.

Figure 20: After four months of healing, an Inclusive^® Scanning Abutment (Glidewell Direct) was connected to the implant, and a digital impression was created using the TRIOS intraoral scanner for the fabrication of the final restoration.

Figures 21a, 21b: The final crown was designed using dental CAD software to mimic the contours of the contralateral tooth. A screw-retained restoration was selected for retrievability and to create an ideal emergence profile.

Figures 21a, 21b: The final crown was designed using dental CAD software to mimic the contours of the contralateral tooth. A screw-retained restoration was selected for retrievability and to create an ideal emergence profile.

Figure 22: The final screw-retained crown was fabricated from BruxZir^® Anterior Solid Zirconia, which was chosen for its combination of strength and lifelike esthetics.

Figure 23: At the final delivery appointment, the temporary crown was removed. Note the papilla development resulting from the use of the BioTemps provisional restoration.

Figures 24a, 24b: The final BruxZir Anterior crown was delivered. The restoration fit well, met the desired esthetic requirements, and did not require any chairside adjustments. The accurate fit and natural emergence profile were predictable outcomes due to the precise digital process used to produce the treatment plan, surgical guide, provisional crown and final restoration.

Figures 24a, 24b: The final BruxZir Anterior crown was delivered. The restoration fit well, met the desired esthetic requirements, and did not require any chairside adjustments. The accurate fit and natural emergence profile were predictable outcomes due to the precise digital process used to produce the treatment plan, surgical guide, provisional crown and final restoration.

Figure 25: After confirming that the tooth was slightly out of occlusion during function and maximum intercuspation, the screw access channel of the crown was sealed using Camouflage^® NanoHybrid Composite (Glidewell Direct).

Figures 26a, 26b: The patient was extremely happy with the final restoration, as well as the efficient, minimally invasive treatment protocol that helped ensure such a predictable, esthetic outcome.

Figures 26a, 26b: The patient was extremely happy with the final restoration, as well as the efficient, minimally invasive treatment protocol that helped ensure such a predictable, esthetic outcome.