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a drill protocol was sent from SICAT.
This drilling protocol informs what drills
were needed, the keys needed for each
implant site and which implant drivers
to utilize for implant placement.
After all of the diagnostics were done,
it was time to get started. The patient
came in for initial preparation and
implant placement. The surgical guide
was placed and a tissue punch was used
through the guide to access the osseous
crest. Based on the pre-op photos, clin-
ical exam and CT scan, it was deter-
mined that there was enough keratinized
gingiva to utilize a tissue punch without
risk of having a poor esthetic outcome.
After the tissue was removed, the
Facilitate kit from Astra was used with
disposable Astra drills to create the oste-
otomy through the SICAT surgical guide.
With the full-guided ability of the Astra
Facilitate kit, you can thread the needle
and the implants are placed to the exact
depth and angulation that was designed
from our diagnostics (Figs. 8 and 9).
Having complete confidence in where
the implants are going to be also allows
for a very fast and stress-free surgery.
Once the implants were in place,
the adjacent teeth were prepared for
minimal thickness, full-coverage crowns
and temporaries fabricated. Then, resin
temporary abutments were placed and
screw-retained temporary crowns were
fabricated (Fig. 10).
After the implants had fully integrated,
the patient came back for the final prepa-
rations and imaging. The temporaries
had been adjusted for proper occlusion,
and the patient was happywith the shape
and esthetics. She did say she wanted
the centrals a little longer if that was
possible. This would be easy to accom-
plish through the use of the Biocopy
function for restoration fabrication.
The temporaries were scanned in
Biocopy and then removed. The prepara-
tions were then finalized. Full coverage
was done for #6, #8, #9 and #11. Veneer
preparations were done on #5 and #12 to
help fill in the empty buccal corridors.
Sirona TiBases were placed on #7 and
#10, and images of all the preparations
6 7
8 9
10
Fig 1: Frontal pre-op view
Fig. 2: Occlusal pre-op view
Fig. 3: Lips at rest
Fig. 4: Transfer of pre-op wax-up
Fig. 5: Implant crowns proposals
Figs. 6-7: Designs with CBCT scan
Figs. 8-9: Proposed implant placement
Fig. 10: Provisional implant crowns