Page 24 - CEREC Q2 | 2014

22 | CERECDOCTORS.COM | QUARTER 2 | 2014
today, the replacement of missing
or hopeless teeth with dental-implant-
supported restorations is a routine
treatment modality in partially eden-
tulous patients — and a single-tooth,
implant-supported crown has become
the most frequent indication for
implant therapy.
The goal of dental implant therapy is
to provide patients with a predictable,
long-term and stable esthetic and func-
tional treatment outcome. In that regard,
the long-term success of dental implant
therapy is dependent upon a restoratively
driven, correct 3-D positioning of the
implant, coupled with a long-term stable
osseousandsoft tissueframesurrounding
the implant. A peri-implant bone wall of
sufficient dimensions is a prerequisite
for long-term stable peri-implant soft-
tissue contours. This is especially the
case on the facial aspect of implants in
esthetic sites, where a bone wall of 2 mm
to 3 mm thickness is today considered a
requirement to prevent facial mucosal
recession. Unfortunately, in the majority
of sites with missing teeth, clinicians are
confronted with the challenge of a defi-
cient alveolar ridge.
This article will outline how the utiliza-
tion of guided implant surgery based on
advanced digital and imaging technolo-
gies, coupledwith the surgical technique of
buccal contour augmentation via a layered
bonegraftingtechniquecanleadtopredict-
able and long-term stable
outcomes of dental implant
therapy in sites with alveolar
ridge deficiencies.
Dental Implant
Therapy
The Concept of Layered Bone Grafting
and Buccal Contour Augmentation
C A S E S T U D Y | | | B Y FA R H A D E . B O LT C H I , D . M . D . , M . S .
sites #7 and #10 with the Straumann
Guided Surgery system (Figs. 5-6). The
treatment planning data was then sent
to SiCat in Bonn, Germany, for the fabri-
cation of a SICAT Optiguide. Due to the
limited mesio-distal spacing in sites #7
and #10, it was only possible to place
the small Straumann Guided Surgery
sleeves in the surgical guide, thus
allowing guided osteotomy preparation
but not fully guided implant placement
through the surgical guide (Fig. 7).
The dental implant surgical proce-
dure was performed under intravenous
CASE STUDY
This patient is a 21-year-old male with
a history of congenitally missing maxil-
lary lateral incisors. After completion of
orthodontic therapy, the patient had been
restoredwithbonded,Maryland-typefixed
partial dentures while awaiting comple-
tion of facial growth to replace the missing
teethwith implant-supported restorations.
The initial clinical and radiographic evalu-
ation revealed adequate but borderline 6
mm mesio-distal interradicular spacing
in sites #7 and #10, coupled with a buccal
alveolar ridge deficiency in both sites
(Figs. 1-4). A preliminary treatment plan
was devised to place dental implants in
sites #7 and #10 with simultaneous bone
grafting via the buccal contour augmenta-
tion technique, followed by single-tooth
implant-supported restorations. This treat-
ment planwas tobe confirmedormodified
as needed after cone beam computerized
tomographic evaluation.
A cone beam CT radiographic evalu-
ation was performed with the Sirona
Orthophos XG3D CBCT machine and
diagnostic casts were obtained in order
to have the laboratory perform a prelim-
inary wax-up for the missing teeth #7
and #10. This model was then scanned
with theCERECOmnicamand exported
as CAD/CAM data into the Galileos
implant treatment-planning software
where it was merged with the CBCT
scan, thus allowing the 3-D visualization
of the final restorationswithin theCBCT
scan. The Galileos Implant treatment-
planning software was utilized to plan
two Straumann Bone Level implants in
Fig. 1: Preoperative frontal view of
congenitally missing teeth #7 and #10
Fig. 2: Preoperative occlusal view
Fig. 3: Preoperative periapical
radiograph site #7
Fig. 4: Preoperative periapical
radiograph site #10
1
2
3 4