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CAD/CAM international C.E. magazine of digital dentistry North America Edition, No. 3, 2016

22 I I clinical_ simplifying dentistry taking into account considerations such as occlusal factors and vectors of force. The CAD/CAM scans are easily acquired with Planmeca FIT technology, which allows for accurate digital models and streamlined planning of restora- tions. The digital models, acquired as .stl files, are easilyimportedintoRomexis’cone-beam.dicomfiles to facilitate planning. The digital workflow is exemplified in the follow- ing case involving a 45-year-old patient who was distraught over losing tooth #12. She presented to myofficeafteranoralsurgeonextractedthetoothin an emergency. She requested a temporary replace- ment that was not removable. A composite bonded provisional was fabricated, and the provisional stayed in place for three months prior to implant placement. A cone-beam study is made, and the case is planned virtually (Fig. 5). The intended implant is po- sitionedintheavailableboneinadesiredaxis,taking into account occlusal forces, using, in this case, the outline of the provisional tooth as a guide. The file was emailed to a laboratory to fabricate a tooth-borne surgical guide. In this case, a Nobel Replace-Select 4.3 x 11.5 mm implant was selected, andaguidewasmadetoallowforguidedplacement of the implant (Fig. 6). On the date of surgery, the guide was tried-in to assure an accurate, stable and intimate fit. The win- dowsprovidedbytheguideallowforvisualizationof the proper fit (Fig. 7). With the guide in place, the tissue is marked, and a tissue punch is used to gain flawless access to the osteotomy site, with full confidence of the intended position (Fig. 8). Surgery is performed using the guide and associ- ated instrumentation (Fig. 9). The process is simple and straightforward. Theimplantisfullyseated,withtheentireprocess completed in a relatively atraumatic fashion with CAD/CAM 3_2016 Fig. 5 Fig. 7 Fig. 9 Fig. 6 Fig. 8 Fig. 10

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