Clinical digital workflows for implant crowns

Dr Neeraj Surathu

Tue. 1 July 2025

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Single-unit and short-span restorations present clinicians with an excellent opportunity to utilise digital workflows. These high-accuracy appliances benefit from the precision, consistency and cost-effectiveness that digital systems offer. This article outlines a step-by-step workflow showcasing the advantages of digital techniques.

Phase 1: Implant planning and guided surgery

A well-placed implant is critical for a successful restoration because implant positioning affects the thickness of the restoration, location of the screw access hole, emergence profile and aesthetics. The digital workflow begins with meticulous implant planning using advanced software to design a surgical guide for precise implant placement (Fig. 1).

3D printing of surgical guides
3D-printing technology facilitates rapid, cost-effective production of surgical guides (Figs. 2 & 3). Key considerations when selecting a 3D-printing resin include:

printer quality, as high accuracy ensures a proper fit;
precision, as sleeves must align perfectly with the guide; and
translucency, as it enhances surgical visibility and supports sterilisation.

Fig. 2: 3D-printed surgical guides straight from the printer.

Figs. 3a & b: Surgical guide with a fitted sleeve. Straight from the printer (a). After post-processing (b).

Fig. 4: Soft-tissue maturation three months after immediate provisional restoration in region #14.

Best practices
When nesting surgical guides in slicing software, avoid placing supports near the sleeve hole or intaglio surface. Manual support adjustments may be necessary, but this is not a common problem with supports generated in the artificial intelligence-based software Print Studio (Rapid Shape).

Phase 2: Soft-tissue shaping

After accurate implant placement, shaping the soft-tissue profile is essential for a natural emergence around the restoration. Digital workflows streamline this step using custom healing abutments and provisional restorations.

Custom healing abutments
Custom abutments support soft-tissue profiles and seal extraction sockets. They can be designed preoperatively, thereby eliminating the complexities of traditional workflows and reducing chair time significantly.

Provisional restorations
Provisional restorations are an alternative to custom healing abutments, providing additional flexibility to determine size, form and aesthetics. 3D printing enables precise, cost-effective production of these restorations, which can also be customised with stains and chairside adjustments.

Selecting a good 3D-printing resin for custom healing abutments and provisional restorations
The availability of multiple shades is arguably the most significant factor. High-strength resins will also allow short- to medium-term use. A typical custom healing abutment needs to last through the osseointegration period, whereas a provisional restoration may need to last for the entire phase of soft-tissue healing and maturation (Fig. 4). The ability to polish these resins to a high-quality tissue-compatible finish is crucial to patient satisfaction. Custom healing abutments and provisional restorations also need to fit implant componentry extremely accurately. This means that the quality of the surface finish and the accuracy of the printer cannot be under-estimated.

Fig. 5: Characterisation of 3D-printed implant restoration using a stain and glaze system.

Phase 3: Definitive restoration

Digital workflows ensure a seamless transition from provisional to definitive restorations by replicating the approved provisional and emergence profiles. Restorative interfaces include:

titanium bases, integrating emergence profiles into the design; and
split restorations, combining custom abutments and zirconia or titanium components for tissue-level restorations.

Benefits of 3D-printed restorations

3D-printed implant restorations can be produced with or without models. If an implant model is required, clinicians may use printed gingival mask resins and high-accuracy model resins that incorporate digital implant analogues. The key advantages of 3D printing of implant restorations include:

material strength, promoting reduced force transfer to implants and a durability suitable for definitive restorations;
precision, ensuring excellent marginal fit and adaptability for design changes;
cost-efficiency, having lower equipment costs and enabling simultaneous production of multiple restorations; and
aesthetics, achieving high-polish finishes and supporting compatibility with staining systems (Fig. 5).

Fig. 6: Fractured tooth #14.

Fig. 7: Extracted tooth #14.

Fig. 8: 3D-printed surgical guide to guide implant placement in region #14.

Case example: Immediate implant placement and restoration

A 42-year-old male patient required extraction of his maxillary right first premolar (tooth #14; Fig. 6). The patient’s high smile line and need for immediate rehabilitation posed challenges. Atraumatic extraction preserved the tissue and bone profile (Fig. 7).

Planning and execution
To ensure an ideal emergence profile, implant positioning and intended emergence were meticulously planned using specialised software. A 3D-printed surgical guide enabled pinpoint precision during implant placement (Fig. 8).

Intra-oral scans of the patient’s preoperative condition and the tooth shape from the CBCT scan were utilised to recreate the restorative profile. This process allowed for the fabrication of a 3D-printed shell that closely replicated the original profile (Figs. 9 & 10). This shell was characterised using a stain and glaze system (Rodin Palette Naturalizing Kit, Pac-Dent) to harmonise with the aesthetics of the adjacent teeth. By creating the ideal profile, the soft tissue was adequately supported, preventing any loss of papillary height or soft-tissue contour changes (Fig. 11).

Fig. 9: 3D-printed characterised shell provisional restoration with a vertical stop to guide intra-oral chairside pick-up.

Fig. 10: Intra-oral chairside pick-up of the 3D-printed shell provisional restoration.

Fig. 11: 3D-printed shell picked up using flowable composite and ready to deliver on the day of surgery.

Fig. 12: Three-month post-op image showing healthy tissue with intact papillae, enabling accurate replication of the tissue profile for the definitive restoration.

Postoperative results

The healing of the soft tissue around a polished 3D-printed provisional restoration allowed excellent healing. The provisional restoration was also extremely well tolerated by the tissue and resulted in the development of very healthy tissue, and the position of the papillae was maintained even after the three-month follow-up after implant osseointegration (Fig. 12).

Rapid Shape PRO 20: An ideal solution for digital workflows

The PRO 20 system excels in implant restoration workflows, offering precision and flexibility. Its key features include:

high-accuracy digital light processing technology, ensuring a precise fit and a smooth finish;
open resin platform, supporting compatibility with various materials for different clinical needs;
streamlined workflow design, featuring a perforated build plate, durable resin reservoir and efficient nesting software to enhance productivity; and
material optimisation, utilising nitrogen or vacuum evacuation to achieve superior physical properties and biocompatibility.

Conclusion

Digital workflows in implant dentistry enhance clinical outcomes, efficiency and patient satisfaction. By incorporating advanced tools like 3D printing and CAD software, clinicians can provide predictable, high-quality results while minimising costs. The Rapid Shape PRO 20 system exemplifies the integration of precision, speed and versatility in modern digital workflows.

Editorial note:

This article was published in 3D printing–international magazine of dental printing technology Vol. 5, Issue 1/2025.