Dentists from the Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria found out that proper smile design planning facilitates accurate implant placement and provisionalization that supports existing soft‐tissue architecture. Hence, they described an alternative approach for the planning of immediate implant placement and provisionalization, which uses a new online dental software that predicts the esthetic outcome, according to their recent study published in the Clinical Case Reports.
The use of dental implants for single‐tooth replacement has shown high long‐term success rates. The choice of immediate or delayed implant placement may be made based on the esthetic expectations of the patient and the site of implant rehabilitation.
The ideal indications for immediate implant placement include generally healthy patients with a low surgical risk and good oral hygiene, as well as the replacement of a single tooth in the non-esthetic zone. Immediate implant placement for single‐tooth replacement following extraction in the esthetic zone, however, is not a frequently used approach.
Meeting a patient's expectations in terms of esthetics presents as a major challenge for the dentist. Computer‐aided design and computer‐aided manufacturing (CAD/CAM) technology not only facilitates the process of milling custom abutments with different materials, but also the creation of a prototype of the patient's smile. This guides the treatment planning process and also aids discussion with the patient.
Smile design software like Rebel Simplicity (Visagismlile Ltd.) creates a completely automated 3D digital mock‐up of the treatment outcome on STL files, which are used to print a resin model. A mock‐up for clinical try‐in can be fabricated with a silicon index and bis‐acryl resin, and this provides both a preview of the treatment outcome for the patient, as well as a guide for the clinician during the surgical placement of the implants.
Therefore, the authors studied a case report of a 48 year old woman to describe a faster and easier approach for planning surgical and prosthetic treatment by using a new online‐based digital software that facilitates communication with patients and predicts the esthetic outcome. The patient presented with esthetic concerns regarding her smile, which were attributed to a high smile line, slight chipping of her porcelain crowns. Areas of cementum and dentin resorption were found, in addition to adjacent bone loss on a CBCT scan and an IOPA.
After evaluation of the local factors and considering the fact that the clinical symptoms had been evident for more than 1 year, a treatment plan was proposed for the flapless extraction of tooth 11, followed by immediate implant placement with instant provisionalization.
Digital scanning was conducted, and a single mock‐up defining the new incisal edge position was made for tooth 11. All data were transferred to an online‐based digital laboratory. The authors used an online‐based smile design software (Rebel Simplicity; Visagismlile Ltd.) to create 2D digital designs of the restorations, which were used to guide the complete rendering of the 3D digital model for subsequent printing. The single mock‐up for the incisors was used as a reference for the automatic creation of a complete 3D digital mock‐up (on STL files) for the subsequent printing of a resin model.
The extraction was carried out and the implant was placed. A xenograft material was applied between the flap and the implant in order to prevent bone loss during the healing period. A collagen membrane was placed to promote wound healing and regeneration. Due to the sufficient primary stability of the implant, a provisional implant‐retained restoration was placed without immediate loading.
At the 1‐year follow‐up, no soft‐tissue inflammation or marginal bone loss was observed.
Hence, the authors discussed that dental implants are a viable option following the extraction of teeth with a poor endodontic prognosis due to internal or external root resorption. Smile design software, such as Rebel Simplicity, can be used to resolve a number of dilemmas regarding the choice of surgical approach, as well as materials, positioning, and dimensions used for the prosthetic teeth.