Digital Implant Workflow: From Surgical Plan to Final Crown (1 CEU)

Figures 1a, 1b: Upon clinical examination, the ridge appeared to have adequate width, though there was some narrowing near tooth #29. A CBCT scan and intraoral measurements allowed me to accurately determine ridge dimensions and evaluate whether there was adequate bone volume for implant placement.

Figures 5a, 5b: An occlusal view clearly indicated the placement of the surgical guide and confirmed the trajectory the implant would follow as well as the position of the access hole on the occlusal surface. The detailed surgical report included a cross section revealing the implant’s proximity to vital structures. I could see the outline of the crown, the access channel, the outline of the implant (in blue), and the inferior alveolar nerve canal (in purple). I noted the distance between the implant and the nerve canal as well as the lingual concavity, another very important landmark when placing implants. To avoid complications, the plan maintained a safety zone of at least 2 mm.

Figures 6a, 6b: Further analysis of the CBCT confirmed that this patient had a mixture of D3–D4 bone, which is commonly found in the posterior mandible. While D3 bone is good for implant placement, D4 is less dense and is likely to have lower primary stability. Glidewell HT Implants (Glidewell Direct) worked well in this scenario because their tapered body condenses bone and the deep threads maximize engagement, both of which support implant integration. Because of the bone density, I decided I would not immediately load the implant and instead waited four months for integration before placing the screw-retained crown — which I chose over a cement-retained crown due to ease of delivery.

Figures 7a–7c: For this procedure, I selected a custom Glidewell™ Tooth Replacement Solution bundle, which included a tooth-supported surgical guide, the implant, a custom healing abutment, a scan body, and the final screw-retained restoration. I also used the Glidewell HT Implant Guided Surgical Kit (Glidewell Direct).

Figures 10a–10c: I made sure the reflected tissue flap did not impede the seating of the guide. In this case, I could see the guide was holding the tissue out of the way on the buccal, and I was able to fully see the ridge through the access hole. Using the Glidewell HT Implant Guided Surgical Kit, I started the osteotomy with the 4.3/5.0 mm alignment drill. This drill perforates the alveolar crest and helps to establish a purchase point for all remaining drills in the sequence. The A and B pilot drills helped to provide an osteotomy depth of 8 mm and 10 mm respectively. I then moved on to using the shaping drills. I started with an 8 mm to help begin to widen the osteotomy, followed by the 11.5 mm, to fully widen the osteotomy to the proper size for the implant. The osteotomy was completed and fully visible through the guide.

Figures 11a–11c: A 5 x 11.5 mm Glidewell HT Implant was placed into the fully prepared osteotomy. The implant was torqued to 35 Ncm. A Glidewell custom healing abutment was fully seated and the soft tissue approximated over the ridge. The custom healing abutment was chosen to guide gingival healing for an ideal esthetic outcome.

Figures 12a, 12b: Two interrupted sutures were placed using Biotex™ Non-resorbable PTFE Sutures (available through Glidewell Direct), one on the mesial and one on the distal.

Figures 13a, 13b: Removal of the custom healing abutment showed that the tissue surrounding the implant site was healthy and well contoured.

Figures 14a, 14b: A Glidewell HT Implant Titanium Scan Body (Glidewell Direct) was placed, and proper seating was confirmed with a radiograph. Completely seating the scan body is important. If the scan body is not properly seated, the final restoration will not seat either. Make sure the scan body is screwed into the implant connection and hand-tightened.

Figures 16a, 16b: The laboratory generated a final restoration design, taking into consideration proper contacts and contours for optimal adaptation of the soft tissue to the coronal portion of the screw-retained crown.

Figures 17a, 17b: The final BruxZir Esthetic screw-retained crown was fabricated by Glidewell. After it was seated, the access channel was filled with Teflon tape and sealed with composite.

Figures 18a, 18b: The final restoration seated perfectly without the need for any adjustment. The custom healing abutment created an emergence profile that allowed the final restoration to blend seamlessly with the adjacent teeth and appear to emerge from the tissue like a natural tooth. The result blends well with the adjacent dentition, restoring both function and esthetics.