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implants 2_2016 C.E. article_ esthetic replacement of maxillary premolar I I 07 sions.Adjacentteethprovidedpartialgroupfunction. Once all clinical adjustments were done, a labo- ratory technician was consulted for final shade matching. The initial shade was very close to ideal. The technician accomplished minor modifications (minimal characterization staining and reduction in final surface gloss). Proximal contacts and occlusal tablewerepolishedafterfinalglazing. The crown was lined with silicone tape and then biteregistrationmaterialwasinjectedintothecrown to fabricate a cementation jig (Fig. 12).3 This step is very important to avoid excess cement extrusion duringfinalseatingoftherestoration.4 Allpre-cementationprocedureswerecompleted, including approval by patient of both esthetics and bitecomfort.Abutmentscrewaccessholewassealed with silicone tape, respecting the external contours of the abutment to allow complete seating of the restoration.Thisisacriticalsteptomaintainpatency forfutureaccesstoretentionscrew. The crown was steam cleaned and thoroughly dried. Intraorally, the abutment was thoroughly cleaned and dried in preparation for cementation procedures. Attending dental assistant maintained cheekretractionanddryfield. The walls of the crown were lined with implant cement (Dental Implant Cement, radiopaque, Pre- mier). The crown was then seated on the previously fabricated cementation jig to extrude excess ce- ment. Cement adaptation to internal walls of crown was confirmed and the crown was seated over the custom abutment. Excess cement was removed by combination of hand instrumentation and dental flossafterinitialcementsetting. The crown was left under biting pressure with cotton roll over occlusal table for five more minutes to allow for cement to fully set. Meticulous inspec- tion of sulcus was accomplished to remove any vestigeofimplantcement.Postoperativeradiograph was taken to evaluate complete seating of crown and to confirm removal of any excess radiopaque cement. Occlusion was confirmed and patient was dismissed. One-week recall was accomplished to confirm occlusion and to reevaluate soft-tissue responsetotherestoration. This case study reveals the potential for implant- supportedtoothreplacement.Estheticresultwasex- cellent, and final gingival contours were consistent withadjacentdentition.Thetissuecolorwasnatural anddidnotrevealanyhintoftheunderlyingimplant or abutment. Restoration margins were concealed within the gingival sulcus. This treatment provided an elegant solution for this all-too-common dental emergency. The patient was extremely pleased with theresult(Figs.13-15)._ Note:Theauthorwouldliketoexpressgratitudeto DrakePrecisionDentalLaboratories(Charlotte,N.C.) for all services provided for this treatment. In addi- tion, Dr. Todd Engle, DDS, (Charlotte, N.C.) provided extraordinarycareduringextractionandimmediate placementofimplant. _References 1) Priest,OptimalResultsintheEstheticZonewithCAD/CAM Implant Abutments: A Patient Example Inside Dentistry; 2006;2(3):70-73. 2) WeinbergLA.Reductionofimplantloadingwiththerapeutic biomechanics. Implant Dent. 1998;7:277–285. 3) Wadhwani, Pineyro, Technique for controlling the cement for an implant crown, J Prosthet Dent, 2009; 102: 57–58. 4) Chee, Duncan, Afshar, Moshaverinia Evaluation of the amount of excess cement around the margins of cement-retained dental implant restorations: the effect of the cement application method. J Prosthet Dent. 2013 Apr;109(4):216-221. Fig. 13 Larry R. Holt, DDS, FICD, graduated from the UNC School of Dentistry in 1978. He was in private prac- tice from 1978-2008. Since 2008, he has been the director of clinical education and research at Drake Precision Dental Lab- oratories in Charlotte, N.C. _about the author Fig. 14 Fig. 13_Final patient lateral smile. Fig. 14_Final restoration retracted. Fig. 15_Final restoration occlusal view. Fig. 15