PMC9705096_01
The virtual planning in the specialist software.
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fig1
Inc., Montreal, QC, Canada) digital planning software was used (Figure 1). In this software, the CBCT scan exported in DICOM format (Orthophos SL, Densply Sirona, Bensheim, Germany) was overlapped with the .STL file obtained from patient intraoral scanning with the 3Shape TRIOS 3 scanner (3Shape, Copenhagen, Denmark; Figures 2 and 3).
The planning phases overlapped: intraoral starting point:.STL scan of starting position:tooth #11 virtual extraction.
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fig2
Inc., Montreal, QC, Canada) digital planning software was used (Figure 1). In this software, the CBCT scan exported in DICOM format (Orthophos SL, Densply Sirona, Bensheim, Germany) was overlapped with the .STL file obtained from patient intraoral scanning with the 3Shape TRIOS 3 scanner (3Shape, Copenhagen, Denmark; Figures 2 and 3).
Virtual implant placement planning:superimposition of future implant and the root.
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fig3
Inc., Montreal, QC, Canada) digital planning software was used (Figure 1). In this software, the CBCT scan exported in DICOM format (Orthophos SL, Densply Sirona, Bensheim, Germany) was overlapped with the .STL file obtained from patient intraoral scanning with the 3Shape TRIOS 3 scanner (3Shape, Copenhagen, Denmark; Figures 2 and 3).
Surgical implant stent digital planning.
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fig4
Surgical stent adjusted for Straumann BLX SLActive RB implant 4.0 length 14 mm (Straumann Group, Basel, Switzerland) was 3D printed following the virtual design (Figure 4).
The old crown removal and root preparation/sectioning.
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fig5
The buccal root "shield" in place after sectioning.
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fig6
This resulted in a part of the former root in the area of the buccal bony socket, which was thinned out to a thickness of 2 mm using a round diamond bur (NTI) under sterile saline cooling (Figure 6).
The surgical stent-drill guide fixed in place.
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fig7
BLX full guided surgery (Figures 7 and 8). Before the implant was inserted, a buccal root was smeared with Emdogain gel (Straumann Group) to prevent epithelial proliferation and bacterial colonization, and a microgap was filled with xenograft bone substitute (Straumann Xenograft 0.5 g, Straumann Group; Figure 9).
The occlusal view through stent.
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fig8
BLX full guided surgery (Figures 7 and 8). Before the implant was inserted, a buccal root was smeared with Emdogain gel (Straumann Group) to prevent epithelial proliferation and bacterial colonization, and a microgap was filled with xenograft bone substitute (Straumann Xenograft 0.5 g, Straumann Group; Figure 9).
The implant in place:socket shield can be observed buccally along with some xenograft material.
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fig9
BLX full guided surgery (Figures 7 and 8). Before the implant was inserted, a buccal root was smeared with Emdogain gel (Straumann Group) to prevent epithelial proliferation and bacterial colonization, and a microgap was filled with xenograft bone substitute (Straumann Xenograft 0.5 g, Straumann Group; Figure 9).
The temporary crown on the 3D printed lab model.
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fig10
Temporary crown was fitted, and mesial papilla was repositioned with 5-0 monofilament suture (Prolene, Ethicon, Johnson & Johnson, Somerville, NJ, USA; Figures 10 and 11).
Immediate post-operative with fitted immediate crown and CBCT.
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fig11
Temporary crown was fitted, and mesial papilla was repositioned with 5-0 monofilament suture (Prolene, Ethicon, Johnson & Johnson, Somerville, NJ, USA; Figures 10 and 11).
The final restoration in place with control CBCT after 2 years post-operative.
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fig12
Celtra Ceram, Dentsply Sirona, Charlotte, NC, USA). Crown has been cemented on the implant abutment (RB Variobase  for Crown AS) with the self-adhesive composite cement (Multilink  Hybrid Abutment, Ivoclar Vivadent; Figures 12 and 13).
The occlusal view on the tooth #11 and the soft tissue adaptation to the final restoration.
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fig13
Celtra Ceram, Dentsply Sirona, Charlotte, NC, USA). Crown has been cemented on the implant abutment (RB Variobase  for Crown AS) with the self-adhesive composite cement (Multilink  Hybrid Abutment, Ivoclar Vivadent; Figures 12 and 13).