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ePaper created 2018-02-16, 11:17:41 | version 1.38.0
| case report digital workflow Fig. 4 Fig. 5 at three different heights from the implant level (2, 4 or 6 mm) based on the case and surgeons preference. The combination of drill length (short, long or extra- long) and drill handle (1 or 3 mm) are determined by the implant planning software that provides the sur- gical protocol to use at time of surgery. The Straumann PURE Ceramic Implant system uses a series of “position indicators” that aid in ensuring the correct position of the implant during surgery. Both abutment diameters and heights have corre- sponding position indicators that are placed into the osteotomy for evaluation (Fig. 6). Once the osteo- tomy has been prepared, typically a surgeon will use a “guided implant”, which has a unique driver, to en- sure proper placement of the implant. However, the Straumann PURE Ceramic Implant currently does not have such a driver; therefore, the surgical guide was only used to prepare the osteotomy while implant placement was performed freehand. Bone quality was determined to be Type II. The Straumann PURE Ceramic Implant comes with a separate transfer piece for placement that snaps into place much like the Tissue Level impression cap. Three dots on the driver line up with a flat surface of the abutment por- tion of the implant and also indicate distance to the shoulder (1, 2 and 3 mm). The implant was placed without any incidence to the desired depth and posi- tion of the dots (Figs. 7–9). During the healing phase, a protective cap is placed over the abutment to pro- tect it. Since the patient was concerned with aesthet- ics and has a high smile line, it was decided to place a provisional to provide a more aesthetic appearance. The recommendation by Straumann not to immedi- ately load a PURE implant was taken into account during the DWOS Synergy design session by elimi- nating occlusal and lateral contacts. This provisional was then further modified at time of surgery by fur- ther reducing the anatomy and creating more of a custom healing abutment than immediate provi- sional. The provisional was cemented using tempo- rary cement (TempBond, Kerr) and only two inter- rupted sutures were required to secure the flap. At the one-week follow-up the tissue was healing beau- tifully around the implant and the patient was sched- uled for the final impression seven weeks out (Fig. 10). Fig. 6 Fig. 7 18 CAD/CAM 4 2017