Page 61 - CEREC Q3|2013

quarter 4 | 2013 | cerecdoctors.com | 59
Farhad Boltchi
I still would perform this case guided in my
practice. However, since I no longer do ridge
expansion procedures, I would take a slightly different
approach:
I would either do a staged ridge augmentation and sinus
lift and then come back after six months and place the
two implants via a guided approach in the reconstructed
ridge. Or, depending on the ridge width in site #13, I
would consider throwing in a third implant at no charge
to the patient and place two implants with simultaneous
sinus lifts in sites #13 and #14 via a guided approach while
grafting and augmenting site #12. Then, come back and
restore with a provisional mesially cantilevered FPD
#12-14 off of the two implants after three months, then
place the implant in site #12 in the reconstructed ridge
after an additional three months, and then do the final
single-unit implant restorations after an additional two
months.
T-Bone 3-D Implant Agarwal
Emil, I could very easily argue that CEREC
Guide is way more accurate than any home-
made surgical guide that doesn’t have direct CBCT inte-
gration. Homemade guides are guesses at best, andCEREC
Guide has legitimate accuracy. It’s night and day.
Darin O’Bryan (Faculty)
Emil, the case you showed is fairly straight-
forward to do with guided surgery. You would
need to use a Classic Guide or an Optiguide. For the
narrow ridge, you are going to start with the pilot drill in
the key after doing the ridge split or before, depending on
your preference (if doing ridge expansion, I would just do
the pilot and then use the expanders from there). For the
area of the sinus lift, I plan the angulation with the guide.
In the case you showed, there was 4 mm of bone. I would
put in the software design a 6 mm implant that the base
is just at the sinus floor. This way I can drill to depth and
stop right at the sinus floor. Then you can do the crestal
approach sinus lift and place whatever length implant you
want. If doing a lateral window, then perform that first,
get the membrane out of the way and proceed to make the
osteotomy. In this case, I would design the implant place-
ment to go through the floor of the sinus.
Emil Verban
[In response to Farhad Boltchi]
Thank-you for your thoughts on this case.
Why do you no longer do ridge expansion?
[In response to Tarun Agarwal]
I know you like to argue but there are “educated guesses.”
For sake of argument,
a CEREC Guide
could not be used in
this case due to the
width of the site.
I am familiar with the CEREC Guide.
[In response to Darin O’Bryan]
A CBCT was valuable in this case for me but a generated
guide was not. Just my personal approach that I wished to
share. Thanks for your comments.
[In response to Farhad Boltchi]
I appreciate the fact you can do without increased over-
head. Your 20 years of experience is similar to mine. I can
honestly say that increases in overhead are an issue for me.
An exercise for reflection: I place about 200-250 implants a
year. Iamsure that, asaspecialist, youwillplacemore.Thecost
for a guide canbe $300. $300x250 is $75,000. Nowthat figure
is not “chump change.” Dentistry is not a perfect science, and
the difference between guided and freehand, inmy opinion, is
not clinically significant in 80% of the cases we treat. ... With
that said, please do not share these numberswith yourwife.
Farhad Boltchi
[In response to Emil Verban]
I agree with all your comments, and I have
increased my surgical guide fees by $200-$400 to account
for this increased overhead.
You will like this: A family friend of ours, who is a very
successful business consultant, recently visited my office
and I was showing him all the digital technology and
workflow. While he was very impressed and fascinated, he
toldme that if technology doesn’t make youmore efficient,
more predictable or more profitable, then it’s only a toy.
Well, I can tell you honestly that, right now, I am still in
the “toy phase.” As a referral-based experienced specialist,
I am still trying to figure out how tomake this digital work-
flow be efficient and profitable in my office, and I am defi-
nitely not there yet. However, I think this is very different
for the typical general practitionerwithminimal-moderate