Page 64 - CEREC Q3|2013

62 | cerecdoctors.com | quarter 4 | 2013
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Agree, tap with Straumann but why? Because they are
not self-tapping implants. This is a big advantage with
Implant Direct Implants. They are self-tapping.
Another topic that is not discussed is the design of the
Implant Direct drills. They are stepped drills. They are
fantastic in immediate sites. Each successive drill can be
centered, and there is no walking with the drill. In my
experience, when you go from the 3.5 to the 4.2 with Strau-
mann there is a struggle to keep it centered.
Darin O’Bryan (Faculty)
I would agree with the statement that guides
are a huge advantage for the new surgeon and
the more experience you have, the less a guide is needed.
That being said, a lot of people on this site are just starting
their implant journey, or are like August and like the “no
brainer” approach to guided. I would disagree with that
statement in that the brain work comes into play before
you get to the surgery stage with guided, and the non-
guided requires more effort at the time of placement for
the surgeon who does not have as much experience.
WhenI doan immediatewithout aguide Iuse aLenderman
drill that is side cutting tomake sure the initial osteotomy is in
position and doesn’twalk the drill into the root.
Fully guided is very helpful when placing immediate
molars where you have two to three roots; the implant can
kick down even after the osteotomy is complete. Guided
really helps the novice or beginning surgeon in these cases.
Emil Verban
To see howa small deviationwill affect the apex
of an implant, please view the drawing:
Let me give the Cliff’s Notes version:
When you place the implant, if the axis of placement
changes 4 degrees over 10 mm, it will be close to 1 mm at
the tip of the implant. This is something the guide propo-
nents can sink their teeth in.
Farhad Boltchi
Look guys, we will never resolve this argument
without EtOH involved. Big hug.
Below is an immediate casewith a large incisive canal and
an unusual apical constriction of the ridge right below the
root. Quite honestly, even after nearly 20 years of doing this,
I would have had a very hard time achieving the same kind
of precision three-dimensionally without guided surgery
(BioHorizons Tapered Internal Plus implant BTW).
Emil Verban
Hi August
I think you misunderstood my post. To the
contrary, I was trying to point out the horizontal change
of the apex of an implant with a misdirection of the drill.
For those who are new to drilling in bone, a guide —
whether model-based with the knowledge of a CBCT or a
CT generated one — can be very beneficial.
The drawingwasmade forme by amachinist to illustrate
the change is horizontal when the drilling is not precise.