Page 22 - CEREC Q3|2013
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cerecdoctors.com
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quarter 3
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2013
our goal with implant treatment
should be to strive for ideal results with
maximum efficiency. Luckily, Sirona has
provided us with the technology that
can make this happen. Sirona 3-D CBCT
imaging gives us the ability to diagnose
available bone volume for implant place-
ment and provides a surgical guide for
execution of such a plan. This is especially
important in immediate molar sites.
This case studydemonstrates theSirona
3-D workflow that minimizes patient
visits, creates appointment efficiencies
and maximizes treatment outcomes.
Tammy presents (Fig. 1) as a newpatient
with the chief complaint of a fractured
tooth.We take a 3-DGalileos scan on every
adult patient, so we were able to diagnose
(Fig. 2) the availability of adequate bone
for immediate implant placement with
stability by utilizing the interseptal bone.
The patient expressed interest in
moving forward, so we took an Omnicam
full-arch digital impression (Fig. 3) and
integrated into a Galileos scan. By taking
all the necessary records at this initial visit,
the next visit can be implant placement.
Upon firm, financial arrangements, an
OptiGuide (Fig. 4) is ordered fromSiCAT.
Our 3-D implant workflow calls for a
digital implant level impression at time of
placement. To make this easier and more
efficient, a preoperative digital impression
(Fig. 5) is taken and then the cut tool is used
to cut away the area of implant placement
(Fig.6).Thisallowsustominimizeourscan-
ning time and area after implant placement.
A key factor for immediate
implant placement is bone
preservation during extrac-
tion by utilizing atraumatic
Omnicam + Galileos =
Efficient Implant Workflow
The Digital Fusion of CAD/CAM and Cone Beam
c a s e s t u d y
| | |
b y Ta r u n A g a rwa l , D . D . S .
techniques. My preference in these cases
is to section the tooth (Fig. 7) and remove
individual roots. Following extraction,
the socket is cleaned with a curette and
osteotomy completed (Fig. 8). The use
of a surgical guide is extremely useful for
immediate placement, as the osteotomy
has to be in between the residual extrac-
tion sockets (Fig. 9).
Due to the planned proximity to the
sinus particulate, graft material is placed
in the residual sockets and osteotomy
site (Fig. 10). The surgical guide is used
to guide the implant (Fig. 11) into ideal
planned position and push the graft
material to “lift” the sinus (Fig. 12).
The implant is fitted with the appro-
priate implant level digital scanning body
(Fig. 13) for a digital Omnicam impres-
sion. This is an area where the Omnicam
really shines: it doesn’t require powder.
The implant procedure is completedwith
a placement of collagen plug membrane
and resorbable gut sutures (Fig. 15).
An immediate post-op radiograph (Fig.
16) is taken. It shows ideal implant place-
ment, internal sinus lift and socket grafting.
There are several efficiencies created
by Sirona 3-D technologies in this case
example. First, in a single visit we are
able to diagnose and capture necessary
records for guide fabrication. Second,
with CEREC, a digital workflow is used
to order the digitally milled OptiGuide.
Third, since the Omnicam doesn’t require
powder, we are able to capture a digital
implant-level impression at the time of
implant placement — even in cases where
there is an open flap and/or graft material.
I encourage each reader to consider
investing in technologies that enhance
the services you provide in your practice
and/or to continue to invest in the educa-
tion that allows you to learn new tech-
niques that maximize your investment in
3-D technologies.
For questions and more information,
Dr. Agarwal can be reached at
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