Single implant and short edentulous span restorations present clinicians with an excellent opportunity to utilize digital workflows. These high accuracy applications benefit from the precision, consistency, and cost-effectiveness that digital systems offer. This article outlines a step-by-step workflow showcasing the advantages of digital techniques.
Phase 1: Digital Implant Treatment Planning and Guided Surgery
A well-placed implant is critical for a successful restoration, as implant positioning impacts restorative thickness, screw channel access, emergence profile, and esthetics. The digital treatment workflow begins with meticulous implant planning using advanced software to design surgical guides for precise implant placement. [Figure 1]
[Figure 1]
3D Printing Surgical Guides
3D printing technology facilitates rapid, cost-effective production of surgical guides. [Figure 2] Key considerations when selecting a 3D printing resin include:
- 3D Printer Quality: High accuracy ensures proper fit.
- Precision: Sleeves must align perfectly with the guide.
- Translucency: Enhances surgical visibility and supports sterilization.
[Figure 3] shows an example of a finished 3D printed dental guide with a fitted sleeve.
[Figure 2]
[Figure 3]
Digital Implant Planning Software – Best Practices
After accurate implant placement, shaping the soft tissue profile is essential for a natural emergence around the restoration. Digital dental implant workflows streamline this step using custom healing abutments and provisional restorations.
Phase 2: Soft Tissue Forming
After accurate implant placement, shaping the soft tissue profile is essential for a natural emergence around the restoration. Digital dental implant workflows streamline this step using custom healing abutments and provisional restorations.
Custom Healing Abutments
Custom abutments support soft tissue profiles and seal extraction sockets. They can be designed pre-surgery, thereby eliminating the complexities of traditional workflows and reducing chair time significantly.
Provisional Restorations
Provisional restorations are an alternative to custom healing abutments, providing additional flexibility to determine size, form, and esthetics. 3D printing immediate implant provisionals enables precise, cost-effective production of these restorations, which can also be customized with stains and chairside adjustments.
What do you need to look for in a good 3D printing resin for custom healing abutments and provisional restorations?
The availability of multiple shades is arguably the most significant factor when selecting implant provisional materials. High strength resins will also allow short to medium term use. A typical custom healing abutment needs to last through the osseointegration period while a provisional restoration may need to last the entire phase of soft tissue healing and maturation. [Figure 4] The ability to polish these resins to a high-quality tissue compatible finish is crucial to patient satisfaction. Custom healing abutments and provisional restorations also need to fit implant componentry extremely accurately. This means that the quality of surface finish and the accuracy of a good quality printer cannot be underestimated.
[Figure 4]
Phase 3: Final Restoration
Digital workflows ensure a seamless transition from provisional to final restorations by replicating approved provisionals and emergence profiles.
Restorative Interfaces
- Ti Bases: Integrate emergence profiles into the design.
- Split Restorations: Combine custom abutments and zirconia or titanium components for tissue-level restorations.
Benefits of 3D Printed Restorations
3D printed implant restorations can be produced with or without models. If an implant model is required, clinicians may use printed gingival mask resins and high-accuracy model resins that incorporate digital implant analogs. Key advantages include:
- Material Strength: Reduced force transfer to implants and durability suitable for definitive restorations.
- Precision: Excellent marginal fit and adaptability for design changes.
- Cost Efficiency: Lower equipment costs and simultaneous production of multiple restorations.
- Esthetics: Compatibility with staining systems and high polish finishes. [Figure 5]
[Figure 5]
Case Example: Immediate Implant Placement and Restoration
A 42-year-old male required extraction of his upper right first premolar (#5). [Figure 6] The patient’s high smile line and need for immediate rehabilitation posed challenges. Atraumatic extraction preserved the tissue and bone profile. [Figure 7]
[Figure 6]
[Figure 7]
Digital Treatment Pre-Planning and Execution
To ensure an ideal emergence profile, implant positioning and intended emergence were meticulously pre-planned using specialized software. A 3D printed surgical guide enabled pinpoint precision during implant placement. [Figure 8]
Intraoral scans of the patient’s preoperative condition and the tooth shape from the CBCT were utilized to recreate the restorative profile. This process allowed for the fabrication of a 3D printed shell that closely replicates the original profile. [Figure 9,10] This shell was characterized using a stain and glaze system (Pac-dent, Rodin Palette Naturalizing Kit) to harmonize with the aesthetics of the adjacent teeth. By creating the ideal profile, the soft tissues were adequately supported, preventing any loss of papillary height or soft tissue contour changes. [Figure 11].
[Figure 8]
[Figure 9]
[Figure 10]
[Figure 11]
Post-Operative Results
Consequently, there was no loss of papillary height or change in the soft tissue profile. The healing of the soft tissue around a polished 3D printed provisional allowed excellent healing. [Figure 12] The implant provisional restoration was also extremely well tolerated by tissue and resulted in the development of very healthy tissue and the position of the papillae were maintained even after the 3 month follow up post implant osseointegration. [Figure 12]
[Figure 12]
Rapid Shape PRO 20 Dental 3D Printer: An Ideal Solution for Digital Workflows
The Rapid Shape PRO 20 system excels in implant restoration workflows, offering precision and flexibility. Key features include:
- High-Accuracy DLP Technology: Ensures precise fits and smooth finishes.
- Open Resin Platform: Compatibility with 200+ validated materials for different clinical needs.
- Streamlined Workflow: Perforated build plates, durable resin reservoirs, and efficient dental CAM software enhance productivity.
- Material Optimization: Automatic cleaning system and vacuum evacuation curing for superior physical properties and biocompatibility.
Conclusion
Digital workflows in implant dentistry enhance clinical outcomes, efficiency, and patient satisfaction. By incorporating advanced tools like 3D printing and CAD software, clinicians can provide predictable, high-quality results while minimizing costs. The Rapid Shape PRO 20 system exemplifies the integration of precision, speed, and versatility in modern digital workflows.
