Page 14 - CEREC Q3|2013

12 | cerecdoctors.com | quarter 3 | 2013
implantology is one of the fastest
growing areas of dentistry. With the
accuracy and predictability offered to us
from cone beam technology and guided
surgery, more and more general dentists
are starting to place their own implants.
The restorative dentist plans the restor-
ative portion, and then how the restor-
ative phase relates to the surgical phase.
Immediate placement in an extracted
socket presents its own challenges. If
good primary stability is achieved, then a
temporary can be placed to help maintain
the tissue and allow for the best esthetics.
For the CEREC dentist, this is even
easier with the Omnicam, the Galileos
and the 4.2 Chairside software. Now it
is possible to plan the placement of the
implant, create a surgical guide to aid in
surgery, mill out a temporary and create
the final abutment and crown.
The following case will take you
through a step-by-step process for plan-
ning, placement and final restoration of
an immediate extraction case.
Case Study
The patient is a 64-year-old female with
no significant medical history, in for
routine hygiene care. Upon examina-
tion, #12 was found to have significant
caries underneath the existing porce-
lain-fused-to-metal crown (Fig. 1). The
caries not only compromised the pulp,
but also extended toward the crest of the
alveolar ridge. Root canal therapy and
crown lengthening would be necessary
but, due to the short root, the prognosis
would not be favorable. The
options of a fixed partial
denture or an implant were
discussed. Thepatient opted
Immediate Implant
From Design to Restoration
With 4.2 and CEREC Guide
c a s e s t u d y | | | b y D a r i n O ’ B rya n , D . D . S .
a key. When doing this method, make
sure not to trim too much into the adja-
cent teeth. I tend to leave just the littlest
amount of material on the contact areas
to ensure I don’t have trouble seating the
guide in the patient’s mouth.
The patient returns to the clinic for
removal of tooth #12 and concurrent
implant placement. The patient’s vitals
are taken, informed consent is gone over
and the patient rinses with chlorhexidine
for one minute. The Best Topical Ever is
applied for topical anesthetic and 1.7cc of
4 percent Articaine if given by infiltration.
There are two options at this point: the
first is to cut the tooth off at the gingiva to
the pointwhere the stentwill seat and take
the Galileos scan; the other is to go ahead
and remove the tooth and then take the
CBCT. The advantage of the first method
is that while you wait for the guide to be
milled, you can extract the tooth. The
disadvantage is that it canmake the extrac-
tionmore difficult by not giving you a lot of
tooth structure to get a purchase on. It is
also hard to gauge howmuch of themodel
to trim during the stent fabrication and
for an implant and, due to the proximity
to the esthetic zone, immediate place-
ment and temporization was discussed.
One option for guided surgery would
be to take the Galileos
scan now and order
an Opti-guide from
SICAT. While this
would certainlywork,
it adds expense and
takes more time than
fabricating a chair-
side guide. CEREC Guide works well for
cases with support on both the mesial and
distal. To do a CEREC Guide, the tooth
either needs to already be extracted or
broken at the gum line. This allows for
the seating of the radiographic marker.
In this case, the patient had not lost the
tooth; instead, we took a quick impres-
sion with alginate and created a working
model with Mach II (Fig. 2). The model
is then scanned with the Omnicam to use
as the CAD/CAM data for implant treat-
ment planning. Since the original tooth
and crownwere in a good position, restor-
atively it was used for the design import
into the Galileos scan.
I thenmodified the model by removing
the tooth that was to be extracted (Fig. 3).
Since the tooth will be removed, it is
possible to modify the model all the way
to the gingiva. Thiswill allowfor a greater
thickness ofmilledguidewithout causing
the need for a longer drill. The thermo-
plastic material was then placed and the
radiographic marker seated as much as
was possible (Fig. 4). The markers come
in three sizes: small, medium and large,
which correspond to the size of block,
with a predrilled hole that will allow for
the drill to pass through with the aid of
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