Guided implant surgery with placement of a presurgical CAD/CAM patient-specific abutment and provisional in the esthetic zone.

Parallel use of implant treatment planning software and cone-beam computed tomography (CBCT) can, using certain criteria, consolidate steps and streamline tooth replacement strategies. The authors describe such a case in the esthetic zone whereby flapless extraction and immediate implant placement using CT-guided surgery were performed simultaneously, with placement of a computer-aided design/computer-aided manufactured (CAD/CAM) patient-specific abutment and non-occlusal function provisional in a single visit (supporting the "one-abutment, one-time" concept). An over-retained primary cuspid in a periodontally healthy woman with well-controlled type-2 diabetes was replaced with an implant and CAD/CAM patient-specific abutment in the No. 11 position. A necessary implant-axis angle correction was customized using digital information from a CBCT scan and implant treatment planning software, without the need for site development or a conventional impression. This data integration and streamlined workflow enabled fabrication of a CAD/CAM patient-specific abutment before surgical treatment. The abutment remained in place from implant surgery to the prosthetic phase, with minimal soft-tissue changes, enabling preservation of pink esthetics and expediting treatment. The result was a preserved emergence profile in the presence of high esthetic demands. However, due to slight post-extraction soft-tissue changes, digital reformatting of the abutment was required when the final crown was fabricated, thus limiting the disruption of the biologic width to a one-time occurrence. The importance of case selection for this treatment protocol in the esthetic zone cannot be overemphasized. A thick crestal dentoalveolar bone phenotype (> 1 mm, approaching 2 mm in this case), broad zone of attached and keratinized gingiva (3 mm to 4 mm in this case), adequate peri-implant soft-tissue thickness (> 1 mm in this case), and high primary implant stability (ISQ = 80 in this case) were all critical factors influencing outcome.