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ePaper created 2017-08-25, 17:58:13 | version 1.38.0
| case report digital technology in fixed implant prosthodontics Immediate implant placement in aesthetic zone, followed by final restoration using CARES Digital Solutions Author: Dr André Callegari, Brazil Fig. 1 Fig. 2 Initial Situation A 21-year-old male patient presented to the Clinic Beleza do Sorriso in São Paulo, Brazil, with a fractured element in tooth 21. He was dissatisfied with the aes- thetics in the anterior segment of the maxilla and had multiple active carious lesions in the interproximal regions of teeth 11, 12 and 22 (Figs. 1 & 2). Treatment planning The aim of planning is to set out a path to ensure the best possible outcome for a specific goal. In high per- formance dentistry, diagnosis and treatment planning are key elements of success. The first step in this case was to evaluate the patient's medical history and to confirm that he was in good general health. When starting any aesthetic rehabilitation treatment, a num- ber of aspects must be considered: bone architecture, periodontal biotype, interproximal bone crest level, and smile line. Plaster study models were then created, which, along with photographic documentation and imaging examinations, helped to identify the root fracture on tooth 21 and slight buccal bone loss. We used the concept Digital Reverse Planning (DRP), which allows full virtual planning, from the bone defect aris- ing from the tooth extraction up to the final outcome of the ideal three-dimensional positioning of the im- plant in order to obtain the desired aesthetic result. We opted for the extraction of tooth 21 and imme- diate implant placement. All the necessary informa- tion obtained through tomography was transferred to the software and a virtual guide was accurately designed. The customised guide was milled without metal washers and based on precise measurements to ensure precision placement of the Bone Level Roxolid SLActive 3.3 x 14 mm implant (Figs. 3–5). After placement, the implant was immediately temporised; the adjacent decayed teeth were prop- erly cleaned and prepared for ceramic fragments in order to correct dental rotations and enhance the aesthetics of the anterior region. 16 CAD/CAM 3 2017