A modified protocol for restorative implant abutment selection by using computer-aided design and computer-aided manufacturing technology.

STATEMENT OF PROBLEM: Implant abutment selection is complex because of the numerous factors involved. Computer-aided design (CAD) technology allows for the virtual selection and placement of abutments after all parameters have been precisely measured. The outcome of this new protocol should be validated. PURPOSE: The purpose of this in vitro study was to validate a new digital protocol in which abutment selection is made through a CAD software program, the abutments are virtually placed, and the restoration is then designed based on the virtual abutments to fit the actual abutments when delivered to the implants intraorally. MATERIAL AND METHODS: A cast with 2 parallel implants was scanned 10 times. Then, 2 abutments were placed and scanned 10 times. Twenty identical superstructures were designed and manufactured to simulate the clinical situation of a 3-unit fixed partial denture, screw-retained to 2 implants. These were divided into 2 groups-A, real abutment and B, virtual abutment-and then compared by means of digital and optical measurements. RESULTS: No significant differences were detected for the measurements between the control and test groups in either the x-axis or y-axis; significant differences were found for the median value of the measurements obtained from both groups regarding the z-axis (P=.046). The mean gap in the virtual abutment group was 50 µm and 35 µm in the real abutment group. CONCLUSIONS: Superstructures produced after the virtual selection and placement of intermediate restorative abutments compared favorably with those produced after the digitalization of actual abutments and placement in the implant model, thus validating the proposed digital protocol for virtual abutment selection and placement.

Digital tools and 3D printing technologies integrated into the workflow of restorative treatment: A clinical report.

The development of technologies including intraoral scanners, dental software for digital restoration design, and additive manufacturing has improved the digital workflow of restorative treatment. The present article describes a digital workflow with intraoral scanning, computer-aided design (CAD) software, and subtractive and additive manufacturing procedures for a patient receiving lithium disilicate laminate veneers.

Immediate placement and restoration of implants in the esthetic zone: Trimodal Approach therapeutic options.

Recently, a number of clinical and animal studies have been published suggesting the advantages of using immediate post-extraction implants under a flapless protocol, followed by the simultaneous placement of an implant-supported provisional restoration (Trimodal Approach [TA]). Indications and risk of complications of this therapeutic option have also been thoroughly discussed in the literature. Different protocols have been advocated in order to minimize the possible esthetic impact of the post-extraction remodeling of the bundle bone. These include a correct implant position, a flapless approach, the use of an immediate implant-supported provisional restoration, and filling the osseous gap with different biomaterials or thickening the mucosal compartment through soft-tissue grafts. These techniques have been mostly indicated when intact alveolar walls are present at the time of tooth extraction. In this article, the conventional TA is described. Thereafter, variations of this option are discussed, being the modification of the osseous compartment (TAO), and the modification of the mucosal and osseous compartments (TAOM).

Immediate placement and restoration of implants in the aesthetic zone with a trimodal approach: soft tissue alterations and its relation to gingival biotype.

PURPOSE: The aim of this prospective study was to evaluate the soft tissue changes around implants in the aesthetic zone, placed under a trimodal approach (immediate post-extraction placement, flapless, and immediate provisional restoration) and its relationship to gingival/periodontal biotype of the patient. MATERIALS AND METHODS: The sample consisted of 14 patients from two private practices that were in need of a tooth extraction in the anterior maxillary region (cuspid to cuspid) and were candidates to a replacement with a dental implant. An initial measurement (baseline) of the position or the mesial and distal papillae and gingival zenith was made at this time, with a rigid dental-supported stent and an electronic precision caliper, able to the second tenth of a millimeter; after careful tooth extraction, the periodontal thickness, at a point 5 mm apical to de gingival buccal margin, with an analogical thickness gauge, able to one tenth of a millimeter. Once the implant was inserted an immediate provisional restoration was delivered. To evaluate the soft tissue changes measurements were repeated at 3, 6, and 12 months. A statistical analysis was performed to evaluate the changes in the gingival margin around the implant restorations and to identify a possible correlation to patient's periodontal thickness. RESULTS: All 14 patients received Straumann (®) implants (9 Tissue Level [TL] Regular Neck [RN], 2 TL Narrow Neck [NN], 2 Bone Level [BL] Narrow Crossfit [NC], and 1 BL Regular Crossfit [RC]). All implants integrated and none had any biological complications. Three provisional restorations presented screw loosening and retightened once and one loss retention and was recemented once. In one patient, with a severe bruxing habit, the final restoration suffered screw loosening and was retightened. Of the final restorations, 12 were screw-retained and 2 cemented on custom-made Zirconia abutments. A mean recession of the buccal margin of 0.45 mm was recorded at 12 months ( ± 0.25 mm). An acceptable papilla level was present in all cases at 1 year, with mean changes of 0.38 mm ( ± 0.60) for the mesial and 0.80 mm ( ± 0.90) of the distal papilla, respectively. No correlation could be established between the soft tissue changes and the periodontal biotype of the patient. CONCLUSIONS: Within the limitations of this study, the good aesthetic outcome and minimal complications seem to validate the trimodal approach protocol as a reliable and simple protocol to place and restore immediate implants in the aesthetic zone. No correlation between the patient's gingival biotype and the soft tissue alterations could be established. Additional studies are needed to verify long-term aesthetic results with this approach and to better define and quantify biotypes.