Page 47 - CEREC Q3|2013

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Fig. 21: Galileos Implant virtual plan
for implant in site #22
Fig. 22: Galileos Implant virtual plan
for implant in site #27
Fig. 23: SiCat Classic Surgical Guide
(converted radiographic template)
Fig. 24: Mini-implants after three weeks
healing prior to implant surgery
guided implant osteotomies
in sites #22 and #27. Two
Straumann Bone Level RC
4.1 x 8 mm SLActive implants
were placed in a fully guided
approach (Figs. 26-27).
The flaps were sutured with resorb-
able (5.0 Chromic Gut) and non-resorb-
able (4.0 Cytoplast, Osteogenics) sutures
to allow for a non-submerged healing of
the implant in site #22 and a submerged
healingoftheimplantinsite#27(duetothe
pre-existing soft-tissue morphology) (Fig.
28). The patient’s transitional mandibular
denture was immediately re-inserted and
attached to themini-implants.
The patient returned after two months
of undisturbed healing for uncovering of
the implant in site #27 and for removal of
the mini-implants under local anesthesia
(Fig. 29). The surgical guide was inserted
and attached to themini-implants to locate
the exact position of the implant in site #27
(Fig. 30). Themini-implantswere removed
by simple reverse torqueing; the implant
in site #27 was uncovered via a very small,
buccally positioned flap to establish a
zone of peri-implant keratinized tissue,
and healing caps were placed (Fig. 31). No
sutures were necessary (Fig. 32). Although
it would have been possible to leave the
mini-implants in situ, it was felt that the
increased retention of four Locator attach-
ments, coupled with the patient’s reduced
dexterity, would hinder her ability to easily
remove and re-insert her denture.
The patient was then immediately
referredbacktoherrestorativedentist,who
placed the appropriate Locator abutments
function with her mandibular denture,
which she had beenmissing for so long.
The patient then returned for the cone
beam CT radiographic evaluation. The
patient’s duplicate radio-opaque denture
was seated intraorally in the appropriate
position and attached to the Locator
mini-implants via a chairside hard acrylic
pick-up (Fig. 18). After verifying accurate
seating of this duplicate denture, it was
removed and attached extraorally to a
SiCat biteplate (Fig. 19) for fabrication of a
SiCatClassicGuide radiographic template.
This modified Classic Guide radiographic
templatewasattachedtotheLocatormini-
implants (Fig. 20), and the CBCT radio-
graphic evaluation was then performed
with the Sirona Orthophos XG3D CBCT
21
22
23 24
machine. The Galileos implant-treatment-
planning software was utilized, and two
Straumann Bone Level implants were
planned in sites #22 and #27 (Figs. 21-22).
The radiographic template and the treat-
ment planning data were then sent to
SiCat in Bonn, Germany, for conversion
of the radiographic template into a SiCat
Classic Guide (Fig. 23).
The second surgical procedure was
performed under local anesthesia as well
(Fig. 24). The surgical guide was seated
onto the Locator mini-implants, and the
correct seating and position of the guide
was verified (Fig. 25). Small, bucco-lingual,
full-thickness flaps were reflected in sites
#22 and #27, and the Straumann Guided
Surgery kit was utilized to prepare the