A Guided Solution to Immediate Extract Immediate Placement in the Aesthetic Zone


Case History

The patient is a 53 year old female with no history of medical complications or medications. Tooth #9 was compromised and was planned for an extraction and immediate implant placement.

Capturing the Digital Information

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The patient accepted the proposed implant treatment plan. Dr. Lorenzana utilized Implant Concierge to provide a guided solution for immediate extract/immediate implant placement. The following steps were taken to ensure an accurate and well-fitting surgical guide and Surgery-Ready Provisional.

digital image1

The patient was referred to iMagdent San Antonio where the CBCT scan was captured on a VaTech Green machine.

digital image2iMagdent also captured a digital impression utilizing the iTero Element intra-oral scanner. iMagdent then uploaded both files to the Implant Concierge HIPAA Compliant website on behalf of Dr. Lorenzana.

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Implant Concierge overlayed the digital impression (blue outline) with the CBCT images using the Dental Wings coDiagnostiX software to ensure its accuracy.


Virtual Implant Treatment Planning

vip strip

The presence of tooth #9 on the CBCT was valuable in determining great restorative angulation of the implant for a screw-retained restoration. The implant was planned for immediate placement after extracting tooth #9. Implant Concierge then created an initial treatment plan that was later reviewed by Dr. Lorenzana during an online meeting with a 3D Case Coordinator.


Provisional Design


Once Dr. Lorenzana finalized the implant placement, Implant Concierge proceeded with the provisional design by mimicking the anatomy of the patient's existing #9.


The provisional was purposefully designed out of occlusion to ensure no interference with osseointegration of the implant.


Surgical Guide

surgical1Before Implant Concierge could design the surgical guide, tooth #9 had to be virtually extracted from the digital impression.


A tooth borne surgical guide was designed to seat on the existing teeth post-extraction of tooth #9.

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The Implant Concierge Surgical Guide Protocol outlines the instrumentation, drill sequence, surgical notes, and the implant article number.


3D Printed Surgical Guides




Tooth Borne Surgical Guide

Verification windows verified the surgical guide was fully seated.




Implant Delivery

The Straumann Guided Surgical Kit allowed Dr. Lorenzana to complete the osteotomy and place the implant through the surgical guide to ensure precise trajectory, depth and timing.



The surgical guide was removed and bone graft (Bio-Oss and Gem-21 rhPDGF) was placed around the implant in the extraction socket.


Post Operative Results

post op 1A post-op CBCT scan (red implant) was captured and overlayed with the pre-op CBCT scan (blue implant) to confirm the final implant placement. A 0.4 mm divergence was observed indicating an extremely accurate placement of the implant in comparison to the digital treatment plan.



post op2




The post-operative PA verified the final position of the 4.1 x 14mm Straumann Roxolid SLActive implant. Also pictured is the Straumann Variobase engaging abutment.




post op 3

Delivery of the Surgery-Ready Screw-retained PMMA provisional and contact evaluation.

post op final

Post-operative photo displaying the completed delivery of the Surgery-Ready Screw-Retained PMMA Provisional, shade A1.



Eduardo Lorenzana DDS, MS 

Board Certified in Periodontics

Eduardo R. Lorenzana, DDS, MS, established his private practice in San Antonio, Texas, focusing on Periodontics, Oral Plastic Surgery, and Dental Implant Aesthetics. He earned his certificate in Periodontics and Masters in Oral Biology from Texas A&M - Baylor College of Dentistry in Dallas, Texas, and is a Diplomate of the American Board of Periodontology. He is an Adjunct Assistant Professor in the Graduate Periodontics Department at Texas A&M - Baylor College of Dentistry and Faculty in the Implant Preceptorship in Dental Implantology continuum at The University of Texas Health Science Center in San Antonio. He is a Fellow in the International Team for Implantology (ITI), currently serving as Study Clubs Coordinator for the US Section, and he is Past-President of both the Southwest Society of Periodontists (2016-2017) and the Texas Society of Periodontists (2008-2010).


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