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19 3_2016 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 restora- tions: the effect of the cement application method. J Prosthet Dent. 2013 Apr;109(4):216-21. _references during excursions. Adjacent teeth provided par- tial group function. Once all clinical adjustments were done, a lab- oratory 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 oc- clusal table were polished after final glazing. The crown was lined with silicone 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 during final seating of the restoration.4 All pre-cementation procedures were com- pleted, including approval by patient of both es- thetics and bite comfort. 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 crit- ical step to maintain patency for future access to retention screw. The crown was steam cleaned and thorough- ly dried. Intraorally, the abutment was thorough- ly cleaned and dried in preparation for cemen- tation procedures. Attending dental assistant maintained cheek retraction and dry field. The walls of the crown were lined with im- plant cement (Dental Implant Cement, radi- opaque, Premier). The crown was then seated on the previously fabricated cementation jig to extrude excess cement. 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 floss after ini- tial cement setting. 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, N.C. _about the author 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 inspection of sulcus was accomplished to remove any vestige of implant cement. Postoperative radiograph 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 response to the restoration. _Conclusion This case study reveals the potential for im- plant-supported tooth replacement. Esthetic result was excellent and final gingival contours were consistent with adjacent dentition. The tis- sue color was natural and did not reveal any hint of the underlying implant or abutment. Resto- ration margins were concealed within the gin- gival sulcus. This treatment provided an elegant solution for this all-too-common dental emer- gency. The patient was extremely pleased with the result (Figs. 13-15). Note: The author would like to express gratitude to Drake Precision Dental Laboratories (Charlotte, N.C.) for all services provided for this treatment. In addition, Dr. Todd Engle, DDS, (Charlotte, N.C.) provided extraordinary care during extraction and immediate placement of implant. Fig. 14_Final restoration retracted. Fig. 15_Final restoration occlusal view. Fig. 14 Fig. 15 case report _ aesthetic replacement