| One of the best ways to preserve soft tissue architecture with an immediate implant is to place an immediate temp or custom tissue former. This will support the tissue avoiding collapse. There’s many ways to do this including just making one chairside but this is my preferred methods as they’re precise and can be done before surgery. |
Here you see the surgical guide as well as my temp with a passive pickup hole indexed off the adjacent teeth. This option serves well when doing cases guided or free hand. I’ll show how to make it coming up.
Extraction- root tip was retrieved
Blue Sky Bio Fully Guided Keyless kit used to place a 6 x 11.5 mm Biomax Forte implant
6.0 x 11.5 BSB Forte implant placed fully guided with 50 ncm insertion torque. These implants are really nice for immediates and soft bone as you can get a lot of grab with them
Here’s a tibase placed on the implant after placement. As you can see the tibase emerges right through the center of the passive pickup hole. Now just pick it up and once set, you can remove and cut off the index and add a little flowable to the emergence profile. Unfortunately, I can’t find the pic of the finished product ; (
Ok here’s how I do it. Before planning the implant, I’ll do a virtual waxup in BSB
Now plan the implant backwards from the ideal prosthesis
Once you have it where you want it, you can put a virtual abutment on the implant- in this case a 1.8 mm emergence tibase
Go into the crown and bridge module and you can turn your tooth waxup into a screw retained crown
Emergence profile can be adjusted here. I’ll often segment the tooth root that is being extracted and then match my emergence to that tooth’s profile
Finished screw retained crown design.
If you don’t have adequate stability or just don’t want to immediate load, you can simply cut off the occlusal half of the restoration. Alternatively, you could just print it full contour and grind down the occlusion.
If you prefer the passive pickup hole like in the clinical shots above, just place a virtual custom abutment that’s really long and about 5 mm in diameter. Then you can just boolean subtract it from your crown to create the pick up hole
The implant guide I generated here can serve double purposes. Of course I printed it for surgery but you can also use it as an index for your temp to guarantee the positioning is correct. I’ll just cut out the center of the guide and import/combine the tooth I waxed up……..now just connect the two with some little tube extensions and you have an indexed temp. This gets printed in crown and bridge resin and serves as an awesome temp.
