Page 54 - CEREC Q1 | 2014

52 | CERECDOCTORS.COM | QUARTER 1 | 2014
After a total, uneventful healing time
of four months, the patient returned for
the cone beam CT radiographic evalua-
tion. The patient’s provisional dentures
were duplicated in radio-opaque acrylic
and were seated intra-orally in the
appropriate position and attached to the
Locator mini-implants via a chairside
hard acrylic pick-up.
After verifying accurate seating of the
duplicate dentures, they were removed
and attached extra-orally to two SiCat
biteplates for fabrication of SiCat
Classic Guide radiographic templates.
These modified Classic Guide radio-
graphic templates were attached to the
Locator mini-implants (Fig. 21), and the
CBCT radiographic evaluation was then
performed with the Sirona Orthophos
XG3D CBCT machine. The Galileos
Implant treatment-planning software
was utilized to plan four BioHori-
zons Tapered Internal implants in the
maxilla and four BioHorizons Tapered
Internal implants in the mandible for
implant-retainedmaxillary andmandib-
ular overdentures. However, since a
BioHorizons guided surgery systemwas
not available at the time, this case was
treatment planned with the Straumann
Guided Surgery system (Figs. 22-23).
The radiographic templates and the
treatment-planning data were then sent
to SiCat in Bonn, Germany, for conver-
sion of the radiographic templates into
SiCat Classic Guides.
The second surgical procedure was
performed in the maxilla. The surgical
guide was seated onto the Locator
mini-implants and the correct seating
and position of the guide was verified
(Fig. 24). Limited bucco-lingual full
thickness flaps were reflected to allow
for the osteoplasty of the unevenly
healed alveolar ridge. The Straumann
Guided Surgery kit was utilized to
prepare the guided implant osteoto-
mies (Figs. 25-26), and four BioHori-
zons Tapered Internal implants were
then placed in the preplanned positions
(Fig. 27). The flaps were sutured and the
patient’s transitional denture was then
immediately re-inserted and attached
to the mini-implants. A similar surgical
procedure was performed one month
later to place four BioHorizons Tapered
Internal implants in the mandible
(Figs. 28-29).
The patient returned after an addi-
tionaltwomonthsofundisturbedhealing
(Fig. 30) for removal of the seven transi-
tional mini-implants via simple reverse
torqueing, under local anesthesia,
and attachment of the appropriate
locator abutments to the final implants
(Figs. 31-33). At this time, the patient’s
provisional dentures were re-converted
and attached to the final implants via
chairside hard acrylic pick-up to provide
| | | B O LT C H I
Fig. 24: SiCat maxillary surgical guide
attached to mini-implants
Fig. 25: Guided implant osteotomy
preparation
Fig. 26: Preparation of four guided
maxillary implant osteotomies
Fig. 27: Placement of four maxillary
implants
Fig. 28: Preparation of four guided
mandibular implant osteotomies
Fig. 29: Placement of four mandibular
implants
24 25
26 27
28 29