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CAD/CAM international magazine of digital dentistry No. 3, 2016

nician accomplished minor modifications (minimal characterisation staining and reduction in final sur- face gloss). Proximal contacts and the occlusal table werepolishedafterfinalglazing.Thecrownwaslined with silicone tape and then the bite registration material was injected into the crown to fabricate a cementation jig (Fig. 12).3 This step is very important toavoidexcesscementextrusionduringfinalseating of the restoration.4 All pre-cementation procedures were completed, including approval by patient of both aesthetics and bite comfort. The abutment screw access hole was sealed with silicone tape, respecting the external contours of the abutment to allow complete seating of the restoration. This is a critical step to maintain patency for future access to retention screw. The crown was steam cleaned and thoroughly dried. Intraorally, the abutment was thoroughly cleaned anddriedinpreparationforcementationprocedures. The attending dental assistant maintained cheek retraction and a dry field. The walls of the crown were lined with implant ce- ment (Dental Implant Cement, radiopaque, Premier). The crown was then seated on the previously fab- ricated cementation jig to extrude excess cement. Cementadaptationtotheinternalwallsofthecrown was confirmed and the crown was seated over the custom abutment. Excess cement was removed by a combination of hand instrumentation and dental floss after initial cement setting. The crown was left under biting pressure with cotton roll over the occlusal table for five more minutes to allow for the cement to fully set. Meticulous inspec- tion of sulcus was accomplished to remove any ves- tige of implant cement. A postoperative radiograph wastakentoevaluatecompleteseatingofcrownand toconfirmremovalofanyexcessradiopaquecement. The occlusion was confirmed and patient was dismissed. One-week recall was accomplished to confirm occlusion and to re-evaluate soft-tissue response to the restoration. Conclusion This case study reveals the potential for implant- supported tooth replacement. The aesthetic result was excellent and final gingival contours were con- sistentwithadjacentdentition.Thetissuecolourwas natural and did not reveal any hint of the underlying implantorabutment.Restorationmarginswerecon- cealedwithinthegingivalsulcus.Thistreatmentpro- vided an elegant solution for this all-too-common dentalemergency.Thepatientwasextremelypleased with the result (Figs. 13–15). _ Editorial note: The author would like to express gratitude to Drake Precision Dental Laboratories (Charlotte, NC) for allservicesprovidedforthistreatment.Inaddition,DrTodd Engle, DDS, (Charlotte, NC) provided extraordinary care duringextractionandimmediateplacementofimplant. References 1. Priest. Optimal Results in the Esthetic Zone with CAD/CAM Implant Abutments: A Patient Example Inside Dentistry. 2006;2(3):70–73. 2. Weinberg LA. Reduction of implant loading with therapeutic biomechanics. Implant Dent. 1998;7:277–285. 3. Wadhwani, Pineyro, Technique for controlling the cement for an implant crown. J Prosthet Dent. 2009; 102: 57–8. 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 109(4):216-21. aesthetic replacement of maxillary premolar ce article | 23 CAD/CAM 3 2016 about Dr Larry R. Holt, DDS, FICD, graduated from the UNC School of Dentistry in 1978. He was in private practice from 1978–2008. Since 2008, he has been the director of clinical education and research at Drake Precision Dental Laboratories in Charlotte, NC Fig. 14 Fig. 15 Fig. 14: Final restoration retracted. Fig. 15: Final restoration occlusal view. method. J Prosthet Dent. 2013109(4):216-21. 32016

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