Technology has advanced rapidly and utilizing new digital workflows allows us to design surgical guides and fabricate them chairside with in-house milling or 3D printing.

Surgical procedures have become less invasive and quicker, resulting in less patient morbidity and fewer complications. The production of this surgical guide is done by merging the information taken from the Galileos in DICOM format and the soft tissue and teeth information taken from the CEREC in SSI format.

This information is superimposed in the software and utilized to design a digital wax-up and virtual implant position. The guide is designed, and the information is transferred back to CEREC and milled from a CEREC Guide Bloc on a CEREC MC XL.

This visual essay will walk the reader through a fully guided implant placement and definitive restoration workflow utilizing the CEREC system.

Edentulous first premolar area from an occlusal view.
Edentulous first premolar area from the front.
A CEREC digital wax-up.
Virtual implant planning based on the digital wax-up and CBCT information.
CEREC surgical guide design.
Final design of the surgical guide with windows to confirm seating.
Final milled surgical guide designed on CEREC Guide Bloc.
Milled surgical guide using CEREC MX CL and CEREC Guide Bloc.
Front and occlusal view of the milled surgical guide.
Occlusal and frontal view of the milled surgical guide seated intraorally.
Drilling sequence of the Straumann Dental Implant System through the CEREC guide using the Sirona drilling keys.
Radiographic sequence of the guide pin, implant placement and abutment seating.
Front and occlusal view of the placed implant.
Front and occlusal view of the Straumann Variobase and scan body.
CEREC design of the screw-retained implant provisional restoration.
Provisional restoration milled from a Telio CAD PMMA block.
Provisional restoration bonded to the Variobase.
Front and occlusal view of the provisional restoration intraorally.
CEREC design of the screw-retained implant definitive restoration.
Final restoration milled from e.max CAD block.
Final restoration milled from an e.max CAD block and Variobase.
Final restoration milled from an e.max CAD block after crystallization.
Front and occlusal view of the final restoration intraorally with last periapical radiograph.

When looking at the versatility of the CEREC system, there is an efficient digital workflow that allows you to three dimensionally predict the final placement of a single-tooth implant and forecast the esthetics of the final restoration to fabricate the surgical guide, provisional and definitive restoration without the need of a conventional impression.

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.


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