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aesthetic replacement of premolar CE article | Fig. 14 Fig. 15 patient was dismissed. One-week recall was accom- plished to confirm occlusion and to re-evaluate soft tissue response to the restoration. Fig. 14: Final restoration retracted. Fig. 15: Final restoration occlusal view. Photos provided by Dr Larry R. Holt. This case study reveals the potential for implant- supported tooth replacement. The aesthetic result was excellent, and final gingival contours were con- sistent with adjacent dentition. The tissue colour was natural and did not reveal any hint of the underlying implant 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 the result (Figs. 13–15). _ Note: The author would like to express gratitude to Drake Precision Dental Laboratories (Charlotte, NC) for all services provided for this treatment. In addition, Dr Todd Engle, DDS, (Charlotte, NC) provided extraordinary care during extrac- tion and immediate placement of implant. 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 bio- mechanics. 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 meth- od. J Prosthet Dent. 2013 Apr;109(4):216–221. about Dr Larry R. Holt, DDS, FICD, graduated from the UNC School of Dentistry in 1978. He was in private practice from 1978 to 2008. Since 2008, he has been the director of clinical education and research at Drake Precision Dental Labora- tories in Charlotte, NC. CAD/CAM 2 2017 35 Once all clinical adjustments were done, a labora- tory technician was consulted for final shade match- ing. The initial shade was very close to ideal. The tech- nician accomplished minor modifications (minimal characterisation staining and reduction in final sur- face gloss). Proximal contacts and occlusal 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 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 the retention screw. The crown was steam cleaned and thoroughly dried. Intraorally, the abutment was thoroughly cleaned and dried in preparation for cementation procedures. The attending dental assistant main- tained cheek retraction and a dry field. The walls of the crown were lined with implant ce- ment (Premier Implant Cement, radiopaque, Premier). The crown was then seated on the previously fab- ricated cementation jig to extrude excess cement. Cement adaptation to the internal walls of the crown 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 cot- ton roll over the occlusal table for five more minutes to allow for the cement to fully set. Meticulous in- spection of the sulcus was accomplished to remove any vestige of implant cement. A postoperative radi- ograph was taken to evaluate the complete seating of crown and to confirm removal of any excess radi- opaque cement. Occlusion was confirmed and the