1. Patient situation — exactly as it landed on the bench
We write down what the clinic sent us. Nothing else.
Field | What was in the Rx | Why it matters to the lab |
|---|---|---|
Site | #14 (upper right first molar), single unit | Posterior maxilla, so sinus floor is in play |
Time since extraction | ~4 months | Early enough that the ridge is still remodeling; late enough to plan placement |
Residual bone under the sinus floor (CBCT) | ~3.8 mm | ITI's presurgical planning review treats a residual ridge height of 4 mm or less as severely deficient and recommends a lateral window approach at that point (ITI — sinus floor elevation, Part I: presurgical planning) |
Buccal plate | Clinical note: thin, no measurement | We flagged this and asked for a slice. The ITI consensus on buccal wall thickness recommends >1.5 mm at placement to protect long-term peri-implant health (ITI consensus — influence of buccal bone wall thickness) |
Occlusion | Normal class I, no bruxism noted | Steers the material and the minimum thickness we'll leave on the occlusal surface |
Adjacent teeth | Natural #13 and #15, both vital, no large restorations | Means we're building to real tooth shade and real contour next door — no "safe" neighbors |
Patient medical note from the clinic | Non-smoker, no uncontrolled systemic disease | Smoking is the one systemic factor with a pooled number attached to it — a meta-analysis of 13 studies puts it at +0.164 mm of peri-implant bone loss per year (systemic risk factors for peri-implant bone loss: systematic review and meta-analysis). It wasn't a variable here |
What the clinic had already decided | Lateral-window sinus augmentation + delayed implant placement | So our starting line is: graft at d0, implant later, restoration later still |
We don't write "severe bone loss." We write "3.8 mm residual bone." That's a number the dentist can check against the slice, and it's a number we can design around. The point of this section is not to re-diagnose the patient — it's to make sure the input parameters on our side match the input parameters on the clinical side.
2. What the dentist asked us for
Four asks. Only four. We quote them in the order they came in, because the order ended up mattering.
- Match the restorative window to the surgical staging. "Tell us when you can take the final impression and when you can deliver the crown — I don't want to promise the patient a date I can't hit."
- Keep #14 single-tooth, screw-retained if possible. "I'd rather hand you an access channel than cement a crown over this much bone work."
- Give us a provisional strategy that supports soft-tissue shaping. "By the time we uncover the implant, I want the emergence profile designed, not improvised."
- Put the final restoration on a material that forgives a thinner occlusal than I'd normally leave. "Space between #14 and the opposing cusp is tight; I need you to earn back the millimeter."
Three of those asks are lab decisions (parts, provisional, material). One (ask #1) is a scheduling decision that only works if the lab and the clinic read off the same timeline.
A note we send to every dentist on a sinus-lift case: recommended torque values and the final decision to load belong to the implant manufacturer's IFU and to the surgeon, not to us. We can mill, we can design, we can suggest — we don't dial the torque wrench.
3. The scheduling answer — the part the dentist actually came for
This is the heart of the page, because this is the question the lab is uniquely qualified to answer and it is the question that gets a one-line, hand-wavy answer almost everywhere else. We built a timeline against our own in-house turnaround, then we gave the clinic the two numbers that matter: lab working days and clinic calendar days.
3.1 The in-house workflow for this case
Our standard turnaround from the knowledge base is 2–3 working days for a conventional crown/bridge and 5–7 working days for a complex implant or full-arch case. For a single implant crown with a stock-platform-matched Ti base and a cement-on-zirconia on top, this case sits in the 2–3-day block — but only once the implant is restoration-ready and the scan body data lands.
What's inside those working days:
Stage | Who | Working time |
|---|---|---|
Case intake + Rx cross-check (scan body library, platform, diameter, connection, antagonist) | Case coordination team | within 1 working day of file receipt |
CAD design (crown contour, emergence profile, screw channel direction, interproximal contacts) | CAD design department (~100 technicians) | ~0.5 working day |
Design screenshot sent back to the clinic for sign-off | Case coordinator | gated by clinic reply — not counted in our quoted turnaround |
3D-printed model + CAM milling of the zirconia crown + bonding of the Ti base | Milling + implant department (~70 + ~80 technicians) | ~1 working day |
Glaze, polish, two interproximal and occlusal checks on model, final QC on a dedicated inspection station (independent from the maker) | Ceramics team + QC department (~25) | ~0.5–1 working day |
Pack: crown + Ti base + prosthetic screw + sealing material + hard copy of the design screenshot | Dispatch | same day as release |
3.2 How that in-house turnaround maps onto a sinus-lift case
The slow part of a case like this is biology, not the mill. Public evidence on timing after a lateral-window sinus augmentation is not a single number: the ITI systematic review on placement and loading protocols in partially edentulous patients sets out immediate, early and conventional options rather than one blanket "wait X months" figure (ITI — implant placement and loading protocols in partially edentulous patients, PDF). The surgeon owns that call. What we can do is write our dates against theirs.
For this case, the dentist's clinical plan was: sinus augmentation first, implant placement later once the graft had organized, then restoration once the implant was restoration-ready. We built our timeline in relative days from the day the lab received the final scan-body file (d0 lab), not from the day of the sinus procedure.
Milestone | Who drives it | Relative day |
|---|---|---|
Lab receives final impression / intraoral scan with scan body + opposing + bite + crown shade photos | Clinic | d0 lab |
Scan validation (margin clarity, holes, stitching, library match) returned to clinic | Lab, within 1 working day of file receipt | d+1 lab |
CAD design screenshot sent to clinic for approval | Lab | d+1 to d+2 lab |
Clinic approves design in writing (WhatsApp group or email) | Clinic | gate — stops the clock |
Milling, Ti-base bonding, glaze, QC | Lab | 1–2 working days after approval |
Ship | Lab | same day as QC release |
International courier (clinic-managed) | Carrier | per clinic's forwarder |
Delivery appointment with the patient | Clinic | clinic schedules once the parcel's in |
So the quoted turnaround for this case was: scan to shipment, 2–3 working days of lab time, plus whatever time the clinic takes to approve the design. That's the sentence the dentist pinned to the top of the group chat.
A reality check we include in every quote: customs delays are not our clock to run. If the box sits at the border, we re-file the tracking and keep the clinic informed; we do not back-date the delivery promise.
4. How we met the clinical asks
4.1 Ask #2 — single tooth, screw-retained if possible
We asked for an extra piece of information: the exact angulation of the implant on the planned slice. On a single posterior molar sitting above a lateral window, the implant trajectory is often tipped palatally or buccally more than the restorative crown wants. The decision rule in our implant department is the one the knowledge base describes:
- If the planned screw channel exits anywhere on the occlusal half of the clinical crown, screw-retained is on the table.
- If it exits on the buccal face of the restoration, we move to an angulated screw channel (ASC) with a compatible Ti base, so the dentist still gets a retrievable restoration.
- If the exit is still unacceptable, we switch to a custom abutment + cement-retained crown, and we tell the dentist why in writing.
For this file, the planned trajectory sat within an acceptable range for a direct screw-retained crown on a stock-matched Ti base. We also kept a backup design on the server for an ASC version, in case the actual placement at surgery deviated. The dentist got both files; the picked file was the direct screw-retained one.
4.2 Ask #3 — provisional strategy that shapes the soft tissue
Standard flow in our implant department for a case like this:
- The dentist uses a custom healing abutment or printed PMMA provisional chairside once the implant is uncovered.
- The provisional sits for the soft-tissue conditioning period the surgeon decides.
- For the final impression, the dentist scans the soft-tissue cuff that the provisional has already shaped — not just the implant platform — and sends that scan along with the scan body data.
- We mirror the emergence profile from the provisional into the final zirconia crown's sub-gingival contour, so the soft tissue doesn't collapse at try-in.
We built the final crown's emergence profile from the provisional scan the dentist sent. The sub-gingival contour was designed in CAD and signed off via screenshot before milling, in line with our rule that full-arch, implant-bridge, and custom-abutment cases must be design-approved before any mill job runs.
4.3 Ask #4 — forgiving material in tight occlusal space
The ask here is specific: the dentist asked us to make the crown work in less occlusal space than the ideal. The knowledge base matches that to a material move, not a style preference:
- Monolithic high-strength zirconia on the occlusal half, because it tolerates a thinner wall at the cusp tips while keeping chip risk down — the posterior-tooth, tight-space scenario the material was built for.
- Minimum crown wall thickness held at the posterior lower-bound (around 0.8 mm on the occlusal), per the material supplier's technical sheet — we don't go below.
- A sintering program that is locked and logged for every furnace cycle, with periodic probe calibration, so the shrinkage compensation value stays within tolerance.
- A dedicated zirconia polishing kit after any chairside adjustment — we send a note on this to every dentist new to our zirconia, because an undisciplined grind-and-polish flow can leave micro-cracks that bite you later.
The crown shipped as a single-layer high-strength zirconia restoration on a matched Ti base, cement-on-zirconia internally, screw-retained externally.
5. QC — the three gates and what each one looks at on this crown
A single-crown implant case runs through our standard three inspection gates. Our internal first-pass release rate from the knowledge base is 95%, defined as "crown passes the final QC on the first time, without being sent back for rework."
Gate | Who | What they check on this crown |
|---|---|---|
Pre-production | Case coordinator | Scan body library match, implant platform/diameter/connection ID from the Rx, opposing + bite present, shade photo quality, antagonist condition noted |
In-process | Floor supervisor | Margin fit on the printed model, interproximal contacts (snug, not tight), Ti-base bonding seat, screw path alignment |
Final | Independent QC technician (does not make the restoration) | Marginal seal on the model, inner surface free of nodules, passive seat on the analog, occlusion in centric + protrusive + lateral, screw-channel threading, no cracks or porosity, aesthetics vs. the shade/photo brief |
6. Final product — the design targets, not the clinical outcome
We stop at design targets. Clinical success is the surgeon's call and the patient's biology, and that's not a sentence we write on a lab page. What we can show is what the restoration was built to be:
- Form factor: Single-unit zirconia crown on a Ti base, screw-retained, matched to the implant manufacturer's platform, diameter, and connection.
- Margins and seating: Marginal gap closed within our in-house tolerance (visual check on model under magnification, cross-check on the analog); passive seat with the retention screw hand-driven, no rock, no spring-back.
- Occlusion: Centric contact light, protrusive and lateral clearance verified on the articulated model; occlusal thickness held at the posterior lower-bound of the material system.
- Emergence profile: Mirrored from the provisional soft-tissue cuff the dentist scanned — not freehanded.
- Aesthetics: Single-layer monolithic zirconia, shade matched to the natural #13/#15 neighbors against the chairside photo brief, surface texture staining added at the glaze stage, not milled in.
- Delivery pack: Final crown + Ti base pre-bonded + spare screw + sealing material option sheet (we don't choose the sealer for the surgeon) + design screenshot + Rx cross-check printout + QC release note.
7. What this file is good for — if you're a dentist, clinic, DSO, or lab reading this
A single-unit dental implants with bone loss case like this one gets 80% of its difficulty from two places that don't show up on a photograph: the staging and the parts. The lab side can take ownership of both.
If you work with us on a similar file, this is what the first message looks like:
- Send the scan + scan body + opposing + bite + crown shade photo. One package.
- Confirm the implant brand, platform, diameter, and connection — a photo of the box label is enough.
- Tell us whether you want screw-retained or you want us to argue the case for cement-retained — we'll put the trade-offs in writing either way.
- Tell us the restorative-window dates on your end. We'll put our lab days against yours and send a single working timeline back.
We're a full-service dental lab, in-house from CAD through QC, FDA-listed for the restoration categories we ship and MDR-notified for the same — and every case that leaves here carries a case number, a QC release note, and a design screenshot the dentist already signed off.
Send it the way you already send cases. Push the scan out of your scanner's own portal — 3Shape, iTero, Medit Link, Shining 3D, Primescan and the rest all export a standard open file — or drop a WeTransfer link, or use the WhatsApp thread we open when the account is set up. Whatever route you pick, the rule is the same: a scan file alone is not a case, and the four missing items are usually the opposing arch, the bite, the shade photo, and the implant label.
We come back within one working day with either a scan validation or a list of exactly what's missing. If you'd rather look at the floor before you ship anything, ask for a video audit — the CAD queue, the mill, the furnace log and the independent QC bench, all on camera.