Abstract: Digital dentistry has transformed implant therapy from a multi-appointment, laboratory-dependent process to a streamlined, chairside workflow that delivers predictable outcomes with enhanced efficiency. This case report demonstrates the complete digital replacement of tooth No. 12 in a 56-year-old patient utilizing a multilayered zirconia block for implants within a fully integrated digital protocol. The workflow incorporated cloud-based software for fully guided surgical planning and custom healing abutment design, 3D printing technology for in-office guide and abutment fabrication, and chairside milling for final restoration delivery. This comprehensive digital approach eliminated traditional laboratory dependencies while achieving a highly esthetic outcome, optimal soft-tissue management, and patient satisfaction in a relatively condensed treatment timeline.
Contemporary implant dentistry has undergone a shift toward digital integration, with studies consistently demonstrating improved accuracy, predictability, and patient outcomes when compared to conventional analog approaches.1,2 The introduction of cone-beam computed tomography (CBCT) has enabled 3-dimensional treatment planning with submillimeter precision, while intraoral scanning technology has eliminated the variability associated with conventional impression materials.3,4
Dental literature has emphasized the importance of prosthetically driven implant placement, whereby the final restoration guides surgical positioning rather than available bone dictating potential prosthetic compromise.5 Computer-aided design/manufacturing (CAD/CAM) workflows have evolved to support this philosophy through integrated software platforms that synchronize surgical planning, guide fabrication, and prosthetic delivery.6
The development of high-strength, esthetic zirconia materials specifically designed for implant applications has further enhanced treatment possibilities. Multilayer zirconia blocks, such as KATANA™ Zirconia ONE for Implant (Kuraray, kuraraydental.com), provide natural color gradation and translucency that mimics natural dentition while maintaining the mechanical properties necessary for long-term function.7,8 Chairside-milled zirconia restorations have exhibited marginal fit values comparable to laboratory-fabricated alternatives, with the added benefits of immediate delivery and enhanced patient satisfaction.9
Cloud-based treatment planning platforms have emerged as game-changers in digital workflows, enabling seamless data transfer between diagnostic, surgical, and restorative phases. These systems facilitate collaborative treatment planning while maintaining complete digital traceability from initial diagnosis through final restoration delivery.
Case Presentation
A 56-year-old male patient presented for evaluation and treatment of tooth No. 12, reporting discomfort and expressing a strong desire to preserve the tooth. Initial referral indicated endodontic therapy as the primary treatment recommendation. The patient had no significant medical history that would contraindicate implant therapy, and his dental history revealed extensive structural damage to tooth No. 12 due to gross recurrent decay beneath an existing restoration.
Clinical Examination and Diagnosis
Clinical examination revealed that tooth No. 12 presented with extensive carious involvement extending subgingivally with significant structural compromise. Upon access and thorough evaluation, removal of decayed tissue confirmed that the remaining tooth structure was insufficient to support long-term restoration. The tooth was deemed nonrestorable, necessitating extraction and replacement therapy.
CBCT evaluation (Sidexis, Dentsply Sirona, dentsplysirona.com) revealed favorable bone dimensions for implant placement, including the following: mesiodistal width: 9 mm; buccolingual width: 7.3 mm; vertical height (apicocoronal): 17 mm. Bone density analysis demonstrated a density value of 1,345 Hounsfield units with a trabecular percentage of 33.31%, consistent with high-quality type II bone classification, providing excellent conditions for achieving primary stability.10
Soft-tissue evaluation revealed healthy, well-keratinized tissue with no signs of inflammation, recession, or scarring. Adjacent teeth Nos. 11 and 13 were examined and found to be structurally sound with stable periodontal conditions, providing reliable reference points for implant positioning and emergence profile development.
Treatment Planning and Rationale
Given the patient’s desire for a fixed, long-lasting solution and the favorable anatomical conditions present, implant therapy was selected as the optimal treatment approach. No alternative treatment options were presented, as the extraction site was prepared for implant therapy at the time of tooth removal. The treatment plan incorporated immediate socket preservation with bone grafting following extraction to optimize the implant site for future placement. A healing period was planned to allow for adequate bone regeneration and soft-tissue maturation before implant placement.
Product Selection and Rationale
Zirconia block for implant restoration: As a long-term user of KATANA products, including KATANA Zirconia ONE and ONE Speed, the author was confident in the consistency in strength, esthetics, and marginal integrity they provided and selected KATANA Zirconia ONE for Implant block for this restoration (Figure 1). The multilayer design of this material mimics natural dentition by providing beautiful color transitions from cervical to incisal regions without requiring external staining or characterization procedures. This enhances esthetic outcomes while enabling chairside efficiency and allowing for immediate delivery of cosmetically appealing restorations. The material’s compatibility with CEREC® (Dentsply Sirona) milling technology facilitates predictable fit and finish with minimal adjustment requirements.
Cloud-based platform integration: The URIS implant system’s (URIS Inc., urisimplants.com) restorative-driven design philosophy aligns well with contemporary digital workflows. The launch of TruSuite, a cloud-based platform including Pylon and TRUST software (TruSuite, trusuite.truabutment.com), allows for complete digital integration from surgical planning through final restoration delivery.
Pylon software was utilized for comprehensive surgical guide design, incorporating CBCT data and prosthetic objectives to determine optimal implant positioning (Figure 2). The software’s intuitive interface allowed for precise virtual implant placement with consideration for both bone anatomy and final restoration requirements. TRUST software enabled custom healing abutment design, allowing for precise emergence profile control from the day of implant placement.
In-house 3D printing: For a digital practice, in-house 3D printing capability is essential for workflow efficiency and quality control. The SprintRay Pro 55 (SprintRay, sprintray.com) enabled rapid, accurate surgical guide printing with the precision necessary for guided implant placement (Figure 3). The Pro 55S, paired with the Crown Kit (SprintRay), produced the custom healing abutment with precise emergence control, facilitating optimal soft-tissue shaping from the start.
The accuracy and speed of the 3D printing technology used in this case supports complete workflow autonomy, eliminating external laboratory dependencies and associated delays while maintaining complete quality control over all printed components.
Chairside integration: With more than 20 years of experience as a CEREC clinician, the author has found that chairside restoration delivery represents a cornerstone of practice efficiency. The combination of CEREC technology with TruAbutment’s timed Ti-bases and KATANA Zirconia ONE for Implant blocks creates a fully integrated digital workflow that eliminates traditional laboratory outsourcing. The compatibility between these systems ensured predictable fit and function while enabling single-visit restoration delivery with superior esthetic, biologic, and functional outcomes.
Treatment Procedures
Phase 1: Extraction and Socket Preservation
Tooth No. 12 was extracted using atraumatic techniques to preserve the buccal plate and maximize soft-tissue architecture. Immediate socket preservation was performed using bone grafting material to maintain alveolar dimensions and optimize the site for future implant placement. The extraction site was allowed to heal for an appropriate period to ensure adequate bone regeneration.
Phase 2: Digital Planning and Guide Fabrication
Three months post-extraction, comprehensive digital planning was initiated. CBCT imaging was acquired using Axeos technology (Dentsply Sirona), providing detailed 3-dimensional anatomical information. Intraoral scanning (Primescan, Dentsply Sirona) was performed to capture precise soft-tissue contours and adjacent tooth relationships.
The acquired data was imported into Pylon software for virtual implant planning. A URIS OMNI Fixture Implant (4 mm x 11.5 mm) (URIS Inc.) was virtually positioned to achieve optimal prosthetic emergence while ensuring adequate bone engagement. The timed surgical guide was designed to provide precise implant positioning with consideration for both surgical access and final restoration requirements.
Simultaneously, TRUST software was utilized to design a custom healing abutment that would establish an ideal emergence profile from the day of implant placement (Figure 4). This approach eliminates the tissue remodeling often required with stock components and accelerates the achievement of optimal gingival architecture.
Both the surgical guide and custom healing abutment were printed in-house: the surgical guide was printed on the Pro 55 printer, while the healing abutment was fabricated using the Pro 55S with Crown Kit for enhanced precision.
Phase 3: Implant Placement
The surgical procedure was performed using the 3D-printed guide to ensure precise implant positioning according to the digital plan. The guide was evaluated for passive fit and stability prior to osteotomy initiation. The URIS OMNI Fixture Implant was placed according to manufacturer protocols, achieving excellent primary stability in the high-quality type II bone (Figure 5).
The custom healing abutment was immediately placed, providing optimal emergence profile development from day one. The predetermined emergence contours facilitated ideal soft-tissue shaping during the healing period, eliminating the need for tissue manipulation at the time of restoration delivery.
Phase 4: Final Restoration Delivery
After a 3-month healing period, the implant site was evaluated for integration and soft-tissue maturation. The healing abutment had successfully shaped the peri-implant tissues, creating an ideal emergence profile for the final restoration (Figure 6).
The healing abutment was removed, and digital impression was captured using Primescan with a TruAbutment URIS Regular GH2 CEREC scan post. The digital impression data were processed in CEREC software for crown design, incorporating optimal contacts, occlusion, and emergence profile characteristics.
The final restoration was designed to blend seamlessly with adjacent natural dentition while providing appropriate function and facilitating effective oral hygiene. The crown was milled from KATANA Zirconia ONE for Implant block using a CEREC Primemill (Dentsply Sirona) with fine milling strategy to obtain optimal accuracy and surface finish.
Post-processing included careful finishing and polishing to achieve natural surface texture and luster. The restoration was bonded to a TruAbutment Ti-base using PANAVIA™ V5 Opaque cement (Kuraray) following appropriate surface preparation protocols. The intaglio surfaces were sandblasted with 50 µm aluminum oxide at 1.5 bar pressure to promote optimal adhesion.
The completed restoration was seated and torqued to manufacturer specifications (Figure 7). The screw access was sealed with composite resin, and occlusion was refined to ensure optimal function within the patient’s envelope of function.
Treatment Outcomes and Follow-up
The patient tolerated all procedures exceptionally well throughout the treatment sequence, which required just four appointments over 6 months. Initial anxiety regarding implant placement was quickly alleviated by the precision and efficiency of the guided surgical approach. The patient was particularly impressed with the digital workflow’s accuracy and the minimal discomfort experienced during all procedures.
Upon final restoration delivery in June 2025, the patient expressed extreme satisfaction with both the esthetic outcome and functional performance of the implant crown. The restoration exhibited excellent integration with surrounding soft tissues, natural emergence profile, and seamless color matching with adjacent dentition (Figure 8).
Early follow-up evaluation demonstrated healthy peri-implant tissues with appropriate keratinized tissue width and absence of inflammation. The restoration was functioning optimally within the patient’s occlusal scheme without signs of mechanical complications. Radiographic evaluation confirmed appropriate bone levels and implant stability.
Long-term follow-up appointments are scheduled to monitor implant stability, tissue health, and restoration performance over time. The patient has been provided with appropriate maintenance instructions to support long-term success.
Conclusion
The integration of KATANA Zirconia ONE for Implant within a comprehensive digital workflow represents a significant advancement in contemporary implant dentistry. This case demonstrates that properly executed digital protocols can deliver superior outcomes with enhanced efficiency, reduced appointment requirements, and improved patient satisfaction.
The multilayer design and high-level mechanical properties of KATANA Zirconia ONE for Implant provide clinicians with a chairside-millable material that meets the demanding requirements of implant restorations without compromising esthetic outcomes. When combined with cloud-based planning software, in-house 3D printing, and chairside CAD/CAM technology, this material enables truly transformative treatment experiences.
While success with digital implant workflows requires investment in appropriate technology, comprehensive training, and commitment to standardized protocols, the benefits to both clinician and patient justify the investment through improved outcomes, enhanced efficiency, and elevated patient experiences.
DISCLOSURE
This article was commercially supported by Kuraray.
ABOUT THE AUTHOR
Daniel Vasquez, DDS
Private Practice, Oceanside, California
