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60 | cerecdoctors.com | quarter 4 | 2013
experience in surgical implant dentistry (not very expe-
rienced like you), where this digital workflow can have
a significant impact. And that’s exactly the reason why
Sirona doesn’t advertise much to specialists.
But I amout to change that as I trulybelieve the total digital
approach is the way of the future. So I will keep on playing
with my toys until I figure this out. And so, in addition to the
reasons I mentioned above for doing guided surgery and all
this digital stuff, the other reason is that it is more fun for me
as it is a change frommy previous monotone drilling into the
bone and dumping in screws day in, day out routine.
Emil Verban
[Responses to Farhad Boltchi]
OK. I get the fact that the mid-life crisis has
set in. I am past that. The $75,000 is a very expensive toy!
Always love the dialogue with you!
...
Holy cow! I hope Tarun does not read this.
...
My last rant.
A case was posted by Daniel showing #5 placed in one
hour and 45 minutes using a CEREC Guide. He received
rave reviews on this placement, and I think his placement
was spot on. I posted a similar case on Dentaltown #5 that
was placed in 10 minutes. I will not comment if my place-
ment was spot on, as I will leave that up to the viewers’
discretion. If you believe your consultant, then Daniel was
“playing with his toy.”
Farhad Boltchi
[In response to Emil Verban]
Pete is right ... but for clarification I have
never performed a ridge split procedure (although it is
better documented in the literature compared to ridge
expansion) Ridge splitting just doesn’t appeal to me as I
don’t see an advantage with this technique.
As for ridge expansion: 14 years ago, while I was still
teaching full-time in our Graduate Perio program, I started
a clinical ridge expansion study with the residents. Despite
buccal bone grafting in addition to the ridge expansion, every
single case we re-entered revealed partial resorption of the
buccal plate, so I aborted the study after approximately 40
cases. And, biologically, it made sense that this would happen
as we were basically destroying the majority of the endosteal
blood supply to the buccal plate with the expansion proce-
dure, and then we were taking away the periosteal blood
supply by reflecting a full-thickness flap and placing a bone
graft on the buccal. Where is the blood supply to the buccal
bone and to the bone graft for that matter going to come
from? BTW, we even tried several cases without buccal flap
reflection and bone grafting, andwe sawbuccal plate resorp-
tion in those cases as well as the periosteal blood supply is
apparently not as significant as the endosteal blood supply.
Now, I am sure the instrumentation and technique have
evolved since then, and that the majority of these implants
placed via ridge expansionwill survive evenwith partial or
complete loss of the buccal bone as did all of our implants
14 years ago. However, nowadays we recommend a buccal
bone thickness of 2 mm for long-term esthetic success
and, in my hands, I can achieve that more predictably with
traditional bone grafting techniques. So that’s why I no
longer do any ridge expansion procedures.
Michael Scoles | Issaquah, Wash.
August, with your experience level, why in
the world would you do that case guided? An
immediate on a single rooted pre-molar?
T-bone, you have a giant office with 57 ops, not everyone
has the luxury of letting a patient hang out in a chair —
they need it for production.
Unfortunately, guided is best for the beginner who prob-
ably isn’t in as good a position to purchase a CBCT. The
more implants you place, the fewer guides you will create.
Whole lot of implants were placed before CBCT existed.
LoveOpti, but still usea lot of plates. Someonementioned
having to scan twice. You can reuse a plate... Unless PT has
next to zero dentistry in their mouth, we scan with a plate.
I returned my Nobel sleeve kit. $2,400 for something
that is basically only good for the pilot drill. ... (Can a
brother get a roll-eyes smiley???)
Emil Verban
I agree. Guided is best for the beginner. Hell, I
never had a CBCT as a beginner. That is why I
developed the drill stop.
You do not have to look for the marking on the drill.
Focus on the axis of placement.
Here is an example: Take a look at thewidth of this ridge.
Why would a guide be needed? Yes, to control the vertical:
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