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Fig. 5: Implant planning with Galaxis.
With this plan, the patient cast model,
and a Sicat biteplate, the Sicat Lab can
fabricate the surgical guide.
Fig. 6: With the Sicat surgical guide, the
surgery was simulated in a cast model.
Locating implant replicas and utilizing
non-engaging temporary post, a four-unit
bridge was fabricated. The template for the
bridge was the patient’s previous bridge.
Fig. 7: The day of the surgery, a temporary
bridge was screwed in place and composite
was used to cover the access holes.
sinus. Impressions were taken for the SiCat
company to fabricate the classic guide and
to have a back-up flipper for the upper-left
side in case of insufficient stability for the
implant-retained temporary. As soon as the
SiCat company delivered the surgical guide,
I used one of her study models without the
bridge, and performed the “surgery” in the
model with three implant replicas and PVS
as the soft tissue (Fig. 6). With three non-
engaging temporary posts, I did a screw-
retainedduplicate of the original bridge. The
day of surgery, the patient’s previous
bridge was removed, and the SiCat
surgical guide was tried for fitting.
Everythingwas ready.
Simple, atraumatic extractions of
#11
and #14 were done. The surgical
procedureand implant placementwas
done fully guided. Puros cancellous bone
packed around the implants in #11 and
#14.
The screw-retained temporary bridge
was placed in position and the access
holes covered with composite (Fig. 7). The
bridge was adjusted and left completely
out of occlusion. Clear instructions were
given to the patient about maintenance,
diet and functioning. She was aware of
the chances of failure if overloaded with
pressure on the left side. I followed up
with the case several times, and the area
was healing within normal limits. Patient
was pampering the side and hygiene was
excellent. The day of the final impression,
the screw-retained temporary bridge was
3
4
5
6
andscanned thepatient (Fig. 3). TheCEREC
was used to do the virtual wax-up (a replica
of the original work, Fig. 4), and exported
as an .ssi file to the Galaxis software, where
the implant planning was simple (Fig. 5).
The case was designed with Nobel Biocare
Tapered Groovy Implants for the areas of
#11, #13
and#14 (size 3.5x 13mm). The roots
of #11 and#14were long and at an angle, and
initial stability for the implants was needed.
13
mm implants would provide stability
enough without getting into the maxillary
Fig. 3: The case was scanned with the
CEREC 3.85 and a bridge was designed.
It’s ready to export as an .ssi file for the
Galaxis Software for implant planning.
Fig. 4: Patient CBCT with Galileos
Comfort for implant planning. The .ssi
file was imposed over the scan images.
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immediate implant placement with bone
graft in the areas of #11, #14 and an implant
in #12 for a four-unit bridge.
For this case, I had two major challenges,
one clinical and one emotional. The clinical
challenges were the thinmaxillary ridge, the
immediate placement and bone graft. The
emotional challenge was that she was very
concernedabout estheticand, as such, some-
thing removable was not an option, not even
during the healing process. To beat both
challenges we used the Galileo’s Comfort