Flapless immediate implant placement and provisionalization in the esthetic zone using a full digital workflow
Dr. Tristan Staas, The Netherlands
“Nobel Biocare's esthetic digital workflow has transformed how we plan and execute esthetic treatments. From precise digital planning to chairside 3D printing of provisionals, it allows for faster, more predictable outcomes and a streamlined experience that patients truly appreciate.”
Patient: 24 years, female
Clinical situation: Trauma at young age, tooth 11 with external root resorption and buccal fistula
Surgical solution: Flapless immediate implant placement and provisionalization (FIIPP)
Restorative solution: Placement of a Nobel Biocare N1™ implant using a surgical template. Placement of a Nobel Biocare N1 Base, filling of the buccal gap with creos™ xenogain block, immediate provisionalization with SprintRay Midas and a NobelProcera® ASC Zirconia Implant Crown
Surgery date: March 23, 2025
Total treatment time: 2 months
Tooth position: #11 (FDI)
Initial clinical situation
Frontal view – initial situation extra-orally (left).
Frontal view – initial situation extra-orally (right).
X-ray of initial situation (left).
Diagnostic CBCT (center).
Gummy smile (right).
Frontal view – initial situation intra-orally: buccal fistula and recession (left).
Occlusal view – initial situation intra-orally: loss of buccal volume (right).
Data collection
DTX Studio
CBCT scan transverse section plane (left).
.STL file (center).
3D view of initial situation (right).
Treatment planning
Implant planning
Sagittal view on implant planning of Nobel Biocare N1 TiUltra TCC NP 3.5 x 15 mm and Nobel Biocare N1 Base NP 2.5 mm (left).
Frontal view on implant and abutment planning (center).
3D view (right).
Surgical procedure
Atraumatic extraction
The central incisor 11 before extraction (left).
Atraumatic extraction of the central incisor 11 (center).
Cleaning of the extraction socket (right).
Osteotomy and placement of implant
Use of the surgical template with a guided pilot drill 2mm (left).
Finalizing the osteotomy with OsseoShaper tool (center).
Placement of a Nobel Biocare N1 TiUltra TCC NP 3.5 x 15 mm (right).
Abutment base placement
Insertion of the Nobel Biocare N1 Base Xeal TCC NP 2.5 mm (left).
Placement of the Nobel Biocare N1 Base Xeal TCC NP 2.5mm at 20 Ncm torque (center).
Placement of the Position Locator Nobel Biocare N1 Base NP (right).
Maintenance of bone volume and stability
Placement of creos xenogain bone substitute with collagen block (7x8x9 mm), 0.25 g, to fill the buccal gap (left).
Once hydrated, the block can be placed in the defect easily (center).
creos xenogain bone substitute with collagen block (7x8x9 mm), 0.25 g (right).
Post-surgical impression
Post-surgical CBCT
Post-op panoramic low resolution small FOV CBCT DEXIS OP 3D (left).
Post-op CBCT scan (center)
Post-op CBCT scan (right).
Post-surgical scan
Intraoral scan with DEXIS IS 3800W (left).
PLY of post-surgical scan (right).
Immediate loading
Design of the provisional restoration on a Nobel Biocare N1 Universal abutment. Ready to be printed with SprintRay Midas.
3D printing, washing, and curing
10 minutes of 3D printing with SprintRay Midas & Ceramic Crown resin A2 (left).
2 minutes of washing with brushes and spray with Isopropanol (following the IFU by SprintRay) (center).
3 minutes of curing with SprintRay NanoCure (right).
Temporary crown finishing and placement
Placement and cementation of the crown to the Nobel Biocare N1 Universal abutment NP (left).
Provisional crown after polishing and make-up (center).
Placement of provisional crown with Omnigrip™ mini and with 20 Ncm torque (right).
Temporary crown finishing and placement
Closing and curing of the screw access hole (left).
Contact points and occlusion adjustments (center)
Temporary crown immediately after surgery (right).
Check-up
Temporary crown in situ (left).
Temporary crown 2 weeks post-op (right).
Digital records & final restoration
Final IOS scan
Situation after removal of temporary crown, 6 weeks post-op (left).
Situation after removal of temporary crown (center).
Placement of Position Locator Nobel Biocare N1 Base NP (right).
Final IOS scan
Scan with DEXIS™ IS 3800 W(left).
PLY file for production of final restoration (right).
NobelProcera Zirconia Implant Crown on Nobel Biocare N1 Base – Final design
Screw channel angulated to 25 degrees for esthetic outcome and maintained strength on the occlusal area (left).
Nobel Biocare N1 Base was chosen to respect the tissue, combined with the individualized cement-free NobelProcera Zirconia Implant Crown (center).
A partial cut-back design was chosen to have a thin layer of porcelain for the best possible esthetics (right).
NobelProcera Zirconia Implant Crown on Nobel Biocare N1 Base – as delivered to laboratory, ready for finalization by the dental technician.
Final crown
Final invidualized NobelProcera Zirconia Implant Crown on Nobel Biocare N1 Base (left).
Final crown in situ (center)
Final crown in situ (right).
X-ray of final crown and implant, 3 months post-op (left).
Final crown in situ, 3 months post-op (right).
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creos xenogain3 methods of application to meet all your bone grafting needs.
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Nobel Biocare N1 systemChange the way you treat patients.
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SprintRay MidasEffortlessly design and print restorations in minutes.
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