| industry report Fast, functional aesthetic solution for anterior tooth trauma Dr Martin Weber, Germany CEREC and oral surgery? In times when patients go to a practice to receive complete, aesthetic, state-of-the-art treatment as quickly as possible, I think they go together very well. I did not always think so. Certainly, CEREC was always interesting; I have used it since 2003, but I did not always find the results convincing. In 2014, I had a closer look at an event in Salzburg, Austria, and learnt two things: the system had been further developed, and in particular, the precision had been improved consider- ably. It fits well in my practice; I use it almost every day because I have many patients who have busy jobs and do not have much time. I experience a great workflow in the practice that gives me maximum flexibility. Depending on the indication and the patient’s wishes, I can decide whether to make the restoration myself or outsource it to a laboratory, which I often do for more elaborate bridges. Then, I send the scan directly to my partner laboratory via Sirona Connect—that is very reliable. I mainly use conventional ceramic materials (VITA ENAMIC, VITA Zahnfabrik; CEREC Blocs C PC, Dentsply Sirona; IPS e-max and Telio CAD, Ivoclar Vivadent; and Celtra Duo, Dentsply Sirona) to treat my patients. The pos- sibility of using implants in the premolar and molar region with screw-retained all-ceramic crowns is especially inter- esting. Sintering or crystallisation in the CEREC SpeedFire furnace is fast and fits smoothly into the workflow. The advantage for my practice, where I also employ two other dentists, is obvious. We produce laboratory tasks right in the practice and have the entire workflow under control, and our patients are satisfied. They are still re- ally impressed by the technology today. They are treated immediately, have no problems thanks to the precise fit, and feel like they are involved because they can watch us create the design and view the planning process live in CEREC. And yes, patients do talk about that with their friends and family. This case study shows how the digital processes, including implant planning, with CEREC work. Treatment of an anterior tooth trauma with an immediate implant The female patient, born in 1989, came to my prac- tice with problems at tooth #21 caused by a childhood trauma. The gingival margins were reddened and bled when probed. The intraoral radiograph showed post- traumatic resorption of the root, and the tooth could therefore not be preserved (Figs. 1 & 2). The tooth was to be replaced by an implant with an all-ceramic crown immediately after extraction. To plan the procedure, a 3-D radiograph (Orthophos XG 3D, Dentsply Sirona) was taken. It was important to assess the available hor- izontal and vertical bone and evaluate apical osteo- lytic processes after the failure of endodontic treatment and in the region of the crestal bone due to progressive dentinal resorption. The integrity of the vestibular lam- ina was preserved, and there was sufficient apical bone to allow immediate implantation with immediate loading (Fig. 3). After scanning the upper jaw, tooth #21 was deleted in CEREC to simulate the initial postoperative situation. The prosthetic proposal for tooth #21 was used to opti- mise implant planning and to produce the surgical guide (Figs. 4 & 5). In the implant planning software (Galileos Implant, Dentsply Sirona), the prosthetic proposal was superimposed over the CBCT data for the optimal posi- tioning of the implant. In this way, sufficient vestibular dis- tance was ensured, and the correct size of the implant for optimal primary stability could be selected (Fig. 6). When extracting tooth #21, it was important to pre- serve the vestibular lamina to allow immediate implan- tation. For this reason, the Sharpey’s fibres were care- fully severed with a periotome, and the tooth was gently removed (Fig. 7). The tooth had pronounced dentinal resorption, confirming the previously made diagnosis (Fig. 8). The SiroLaser Blue (Dentsply Sirona) with a wavelength of 970 nm was used to disinfect the alveo- lus. An OsseoSpeed EV 4.8–15 mm implant (Astra Tech Implant System, Dentsply Sirona) was inserted imme- diately using a surgical guide (SICAT OPTIGUIDE, SICAT; Fig. 9). At > 35 Ncm, sufficient primary stability was achieved. After the intraoperative scan with a ScanPost (Dentsply Sirona) to complete the temporary restoration, the ves- tibular alveolus was filled with a bone substitute material (Figs. 10 & 11). 38 CAD/CAM 3 2018