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Dental Tribune Middle East & Africa Edition | 4/2016 9 mCME ◊Page8 ishedafterfinalglazing. The crown was lined with sili- cone tape and then bite registration material was injected into the crown to fabricate a cementation jig (Fig. 12).3 This step is very important to avoid excess cement extrusion dur- ingfinalseatingoftherestoration.4 All pre-cementation procedures were completed, including approval by patient of both esthetics and bite comfort. Abutment screw access holewassealedwithsiliconetape,re- spectingtheexternalcontoursofthe abutment to allow complete seating of the restoration. This is a critical step to maintain patency for future accesstoretentionscrew. 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 cheek retractionanddryfield. Thewallsofthecrownwerelined with implant cement (Dental Im- plant Cement, radiopaque, Premier). The crown was then seated on the previously fabricated cementation jigtoextrudeexcesscement. Cement adaptation to internal walls of crown was confirmed and the crown was seated over the cus- tom abutment. Excess cement was removedbycombinationofhandin- strumentation and dental floss after initialcementsetting. The crown was left under biting pressure with cotton roll over oc- clusal table for five more minutes to allow for cement to fully set. Me- ticulous inspection of sulcus was ac- complished to remove any vestige of implant cement. Postoperative radiograph was taken to evaluate complete seating of crown and to confirm removal of any excess radi- opaque cement. Occlusion was con- firmed and patient was dismissed. One-week recall was accomplished to confirm occlusion and to reevalu- ate soft-tissue response to the resto- ration. This case study reveals the po- tential for implant supported tooth replacement. Esthetic result was ex- cellent, and final gingival contours were consistent with adjacent denti- tion.Thetissuecolorwasnaturaland did not reveal any hint of the under- lying implant or abutment. Restora- tion 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 withtheresult(Figs.13-15). Note: The author would like to ex- press gratitude to Drake Precision Dental Laboratories (Charlotte, N.C.) for all services provided for this treatment. In addition, Dr. Todd En- gle, DDS, (Charlotte, N.C.) provided extraordinary care during extrac- tion and immediate placement of implant. References 1) Priest, Optimal Results in the Es- thetic Zone with CAD/CAM Implant Abutments: A Patient Example In- sideDentistry;2006;2(3):70-73. 2) Weinberg LA. Reduction of implant loading with therapeu- tic biomechanics. Implant Dent. 1998;7:277–285. 3) Wadhwani, Pineyro, Technique for controlling the cement for an im- plant crown, J Prosthet Dent, 2009; 102:57–58. 4) Chee, Duncan, Afshar, Moshav- erinia Evaluation of the amount of excess cement around the margins of cement-retained dental implant restorations:theeffectofthecement application method. J Prosthet Dent. 2013Apr;109(4):216-221. Fig.11.GoldhueAtlantisabutment inplace. Fig.9.Crownandabutment onanalogmodel. Fig.13.Finalpatient lateralsmile. Fig.12.Cementationjig. Fig.10.GoldhueAtlantisabutment onanalogmodel. Fig.14.Finalrestorationretracted. Fig.15.Finalrestorationocclusalview. Larry R. Holt, DDS, FICD has gradu- atedfromtheUNC School of Dentistry in 1978. He was in private practice from1978-2008. Since 2008, he has been the director of clinical educa- tion and research at Drake Precision Dental Laboratories in Charlotte,N.C. mCMESELFINSTRUCTIONPROGRAM CAPPmea together with Dental Tribune provides the opportunity with its mCME - Self Instruction Program a quick and simple way to meet your continuingeducationneeds.mCMEoffersyoutheflexibilitytoworkatyour own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presentsaregionaloutlookintermsofperspectiveandsubjectmatter. Membership YearlymembershipsubscriptionformCME:900AED OneTimearticlenewspapersubscription:250AEDperissue.Afterthe payment,youwillreceiveyourmembershipnumberandallowingyouto starttheprogram. 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