Page 52 - CEREC Q1 | 2014

50 | CERECDOCTORS.COM | QUARTER 1 | 2014
The dental implant surgical proce-
dure was performed under intravenous
conscious sedation and local anesthesia.
Thefirststepconsistedoftheextractionof
all of the remaining maxillary teeth with
the exception of two (teeth #8 and #15)
(Fig. 5). These were retained to stabilize
the surgical guide along with the previ-
ously planned Nobel anchor pins (Fig. 6).
The Anatomage universal guided surgery
kit was used to prepare the implant
osteotomies via the surgical guide, after
which the guide was removed, and the
remaining two teeth
were extracted.
Six BioHoriozons
Tapered Internal Plus
implants were placed
in a flapless approach
in the preplanned
positions followed
by attachment of six
multiunit abutments,
which were torqued
to 30 N/Cm (Fig. 7).
Since all implants
achieved excellent
insertion torque
values, and all multi-
unit abutments could
be torqued to 30 N/
Cm, a decision was made to proceed
with the immediate loading of the
implants via an indirect conversion of
the provisional acrylic full maxillary
denture into a fixed, screw-retained
provisional acrylic hybrid restoration.
Open tray impression copings were
inserted accordingly (Fig. 8), and a PVS
impression and other occlusal records
were obtained and sent to the labora-
tory for the overnight indirect conver-
sion process. Minor bone grafting
with a cortico-cancellous mineralized
allograft (MinerOss, BioHorizons) was
performed around the exposed implant
threads as needed.
Collacote and Collaplug were placed
into the extraction sockets, and sutured
with resorbable Chromic Gut sutures,
after which the patient was dismissed.
The patient was then recalled the next
day for the insertion and immediate
loading of the implants via the converted
screw-retained acrylic hybrid denture
(Fig. 9). Although all of the implants
were precisely placed in the preplanned
positions, a slight discrepancy between
the tooth positions/seating of the partial
denture used as a radiographic template
and the tooth positions/seating of the
provisional full denture resulted in
| | | B O LT C H I
the screw access holes for three of the
implants being slightly facial to the
incisal edges.
After an uneventful three months’
healing period, the angulation of these
three implants was easily corrected by
insertion of angled multiunit abutments
and re-conversion of the provisional
hybrid denture. The patient was referred
back to her restorative dentist for the final
restorative procedures culminating in
the insertion of the final Prettau Zirconia
(ZirkonZahn) screw-retained hybrid
reconstruction (Figs. 10-12). The dramatic
transformation of the patient’s smile and
facial features can be seen in the pre-oper-
ative (Fig. 13), one-day post-surgical (Fig.
14) and final facial views (Fig. 15).
Fig. 16: Pre-operative smile view
Fig. 17: Pre-operative full mouth
radiographic series
CASE STUDY 2:
MINI IMPLANT-SUPPORTED GUIDE
This patient is a 57-year-old male with
a longstanding history of recurrent
advanced periodontal disease rendering
the dentition hopeless. The initial clinical
and radiographic evaluation revealed
generalized advanced periodontal bone
loss, severe malpositioning of teeth, local-
ized periapical endodontic lesions, a
fractured tooth and a previously placed
osseointegrated implant in site #4 (Figs
16-17). A treatment plan was devised to
extract all of the remaining maxillary and
mandibular teeth, followed by final resto-
ration with fixed or removable implant-
supported maxillary and mandibular
reconstructions. Since the patient had not
16
17