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Initial clinical situation
Failing PFM crown on tooth 8. Gingival recession, vertical super-eruption of the tooth misalignment of the gingival contour compared to tooth 9, inversion of the zenith position, buccal fistula. Challenging case for immediate loading due to malocclusion including a deep bite and poor canine guidance on the right side.
Dynamic navigation for immediate tooth replacement in a single visit: CBCT and IOS scanning, DTX Studio™ implant 3D planning, DTX X-Guide streamlined execution.
Preoperative clinical frontal view and periapical X-ray. Failed PFM crown on upper central incisor right side with a clearly visible fistula on the buccal side and periapical infection and radiolucency.
DTX Studio Implant 3D planning and rendering, and cross section snapped to the implant axis. The implant is positioned to bypass the radiolucency and engage the maximum quantity of native bone to guarantee sufficient primary stability. The angulation was designed to deliver a screw-retained immediate temporary crown.
X-Guide Dynamic Virtual Guidance with 360° of control of implant drilling angulation and position.
Minimally invasive tooth extraction with a flapless approach, removal of the infected periapical tissues, and a careful debridement of the postextractive socket, followed by X-Guide-mediated implant placement, autogenous cortical plate graft to seal the buccal plate perforation, and augmentation with xenogeneic soft tissue matrix to enhance gingival architecture healing and thickening.
X-Guide-mediated implant positioning according to the prosthetically- and surgically-driven coordinates planned in the DTX Studio Implant software (left).
NobelParallel Conical Connection TiUltra NP 3.75 x 18 mm in the postextraction socket placed to allow the housing of the xenogeneic soft tissue matrix (right).
Intraoperative occlusal view after grafting on the buccal side. The xenogeneic collagen matrix packed and secured on the buccal side and interproximally (left).
A screw-retained immediate temporary crown on the Temporary Snap Abutment delivered on the day of surgery (right).
Postoperative view after 2 weeks: the minimally invasive X-Guide driven surgical positioning allowed fast healing and integration of the soft tissue matrix and bone tissue graft.
Frontal view of the definitive screw-retained porcelain fused to NobelProcera ASC zirconia abutment. 3D printed definitive mastercast with removable gum (left).
Palatal view of the definitive screw-retained porcelain fused to NobelProcera ASC zirconia abutment (right).
Natural-looking appearance with continuous improvement of soft tissue outcomes.
Frontal view of the definitive screw-retained porcelain fused to NobelProcera ASC zirconia abutment. 1-year follow-up (top left).
Frontal view of the definitive screw-retained porcelain fused to NobelProcera ASC zirconia abutment. 2-year follow-up (bottom left).
1-year follow-up and 2-year follow-up. Periapical X-ray (right).