PMC9233610_01
Pretreatment clinical photograph showing the fracture of tooth number 21 almost below the cementoenamel junction with no ferrule effect.
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On intraoral examination, tooth number 21 was fractured almost below the cementoenamel junction (CEJ) with no ferrule effect (Figure 1), and secondary caries was found around the margins of teeth 11, 12, 13, 21, 22, and 23.
Radiograph for the diagnosis and treatment planning (a, b).
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On radiographs, tooth 21 also showed no periapical radiolucency (Figure 2(a)). A computed tomography (CT) scan was taken using Orthophos SL 3D (Dentsply Sirona, Bensheim, Germany) (Figure 2(b)).
Design and fabrication of guides. Design of implant surgical guide in software (a), milled implant surgical guide (b), design of esthetic crown lengthening guide (c), and 3D printed esthetic crown lengthening guide (d).
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Then, a surgical guide (Cerec Guide 3, Dentsply Sirona, Bensheim, Germany) was designed by using a designing software (Galileos Software, Dentsply Sirona, Bensheim, Germany) and was milled using a milling machine (MCXL milling machine, Dentsply Sirona, Bensheim, Germany) to create a precise surgical guide (Figure 3). 3D smile design was done by using Digital Smile Design (DSD), crown lengthening guide was designed according to DSD design by using a designing software (Inlab 19 software, Dentsply Sirona, Bensheim, Germany), and the guide was fabricated by a 3D printer (FormLabs Form 2, Formlab, MA, USA).
Try-in of implant surgical guide (a) and crown lengthening guide (b).
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On the surgical day, the dental implant surgical guide and the crown lengthening guide were tried in, and the fit and accuracy were verified (Figure 4).
Atraumatic extraction of tooth 21 (a), dental implant placement using a surgical guide (b), crown lengthening by using a laser (SiroLaser Blue Dentsply Sirona, Bensheim, Germany) with digitally assisted crown lengthening guide (c), and periapical radiograph post dental implant placement (d).
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Provisional crowns in the patient's mouth on the day of the surgery.
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PRIMESCAN  (Dentsply Sirona, Bensheim, Germany). Provisional crowns (splinted) for teeth 11, 12, 13, 21, 22, and 23 were made by milling (VIPI BLOCK TRILUX , VIPI Industria, Pirassununga, SP, Brazil) using the milling machine (MCX5, Dentsply Sirona, Bensheim, Germany) (Figure 6).
Final restorations. Zircona crowns (a), cemented in the patient (b), front view of the crowns in the patient (c), and side view of the crowns in the patient (d).
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Zirconia crowns were sintered and characterized (Figure 7(a)). Products, St. Paul, MN, USA) following the manufacturer's instructions (Figure 7(b)). The patient was satisfied with the outcome, and the patient has been recalled for a recheck (Figures 7(c) and 7(d)).