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opinion _ 3-D technology I evaluations were made and in order to gain a more complete picture of their condition, it was rec- ommended and they agreed to have the enhanced imaging of a CBCT scan. _Case 2—The maxillary central incisor, what are you waiting for? In this case, diagnosing and treatment planning began in 2009, but this patient was also visiting a periodontist who maintained her dentition with prophylaxisvisits.Hedidnotwanttointerveneand intercept teeth that had experienced periodontal bonelosswhoseprognosiswereincreasinglywors- ening. I broached the subject of removing a perio- dontal weakened maxillary central incisor; fortu- nately,thepatientagreedtoanenhancedCBCTscan, which we obtained on 14th of June 2010. Tooth #9 had a long dental history including periodontal surgery, a poor crown to root ratio, extrusion and increasing mobility (Figs. 15 & 16). PeriapicalX-raysclearlyshowedthehorizontalcom- ponent of the bone loss associated with this tooth butnottheextentofbonelossinotherdimensions. I felt that increasing bone loss would also jeopar- dise the adjacent teeth if left untreated. With the CBCTenhancedimagingevaluation,itbecameclear to us that the labial plate was very thin (Fig.17). The treatment plan was devised based upon this diagnostic information, and a fixed solution was proposed for the post extraction site of tooth #9. Going into this treatment, we knew before any im- plant could be placed that an extraction and bone graft would be necessary. It would be impossible if no bone grafting was performed. Treatment was completed on the 27th of July 2010 when I gently removed tooth #9 and bone grafted its socket and buccal wall and crest, util- ising an Infuse bone graft from Medtronic. Infuse is a rhBMP2 or bone morphogenic protein which was tolerated well and without complications by thispatient(Figs.18–21).Aremovableacrylictooth replacement was fabricated and inserted imme- diately after suturing. Healing was uneventful and on21st ofDecember2010anew3-Dscanwastaken witharadiopaquescanapplianceinposition,which was used to evaluate the result of the Infuse bone graft and plan for the virtual implant position and fabrication of a surgical guide (Figs. 22 & 23). A 2012 AAOMR position paper recommended that 3-D imaging be used for all dental implant planning.Boneregeneratedadequatelytoreceivea 3.5 x 13 mm Nobel Active implant in a specifically proposedsite,whichwouldavoidtheincisivecanal and ensure that this implant was properly posi- tioned in 3 dimensions, thereby extending the longevity of any resultant tooth replacement. Flaplessguidedimplantology Flapless guided implant surgery was completed on the 25th of January 2011 via a SICAT surgical guide. Flapless surgery reduces the inflammatory sequelae that follow when conventional flap sur- gery is performed. Patient’s post op was unevent- ful, no swelling no pain. She continued wearing the removable provisional until the implant was fully integrated. Initial torque was 35 Ncm and stability was achieved in the regenerated bone. Three months was allowed to pass for complete integration. I 13CAD/CAM 1_2016 Fig. 30 Fig. 28Fig. 26 Fig. 27 Fig. 29 CAD0116_06-18_Ramirez 21.01.16 11:03 Seite 7 CAD0116_06-18_Ramirez 21.01.1611:03 Seite 7