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QUARTER 3 | 2014 | CERECDOCTORS.COM | 49
The osteotomy was performed
following the SiCat recipe and using
the guided kit from the manufacturer.
All drills were controlled to ensure the
proper angulation and depth, the result
seen in Figure 10. The osteotomy was
irrigated and the implant was placed
through the guide and inserted. The
implant carrier is carefully watched
during the procedure to make sure it
contacts the top of the master sleeve to
provide correct depth on the implant.
In this case, the notches of the carrier
align with the reference marks on the
master sleeve. This step will duplicate
the clocking of the implant so the pre-
surgical model matches your actual
implant placement. Figure 11 demon-
strates the visual marks of the precision
system. The carrier is unscrewed from
the implant, and the guide removed
from the mouth. A bone profiler is used
to ensure that the abutment can seat
without bone interferingwith its seating.
The final e.max abutment is placed and
seating confirmed with an X-ray. The
veneer crown is then tried in and evalu-
ated for fit and occlusal clearance. Once
these steps are completed successfully,
A guided surgery visit is a stress-free
one: all the work is done on the front
end, so it is just a matter of executing as
planned. The surgical site can be seen in
Figure 8, where the graft and soft tissue
have healed well. All material required
is known, and there is no last-minute
scrambling. A local anesthetic was used
to anesthetize the surgical area and
given the time to work. The cantilever
provisional was removed and the ovate
pontic area evaluated, with the guide
both in and out. Attached gingiva lends
stability to our implants. If there is a
thick enough band, then a tissue punch
approach is possible. As seen in Figure 9,
a thin band of attached gingiva would
have remained after a tissue punch
approach. For Lucy, a modified flap was
raised and repositioned to maintain the
attached gingiva.
the abutment screw is torqued to the
manufacturer’s recommended value.
This implant was torqued to 20 n c/m.
Figure 12 show the abutment in place
with Teflon tape filling in the screw
access hole.
RelyX Unicem was used to cement
the adjusted provisional on #13 and the
veneer crown on #12. Figure 13 shows
the patient just prior to her dismissal
from the implant placement visit.
Standard implant surgical technique
is followed to maximize the chances of
proper healing and integration.
And then, we wait.
First week post-op evaluation of soft-
tissue healing was uneventful. Tissue
response was great, as seen in Figure 14.
Even with the usual post-surgery drop in
home care, the soft tissue readily accepts
the e.max material. Occlusion was
rechecked to confirm the passive envi-
ronment. Home care was re-enforced,
and patient was debriefed to understand
her experience.
Many times, for the first-time implant
patient, an “It wasn’t as bad as I thought
it would be” is heard.
One month after the placement, the
patient returns and a periapical X-ray is
taken to confirm the continued healing.
If everything progresses uneventfully,
at around 10 weeks we can start to think
about the definitive restorations.Which, if
the provisionals fit well, is just a matter of
adjusting the proposal back into occlusion
within the software and switching the
material to your choice of final materials.
Because things have progressed so
rapidly in dentistry, we owe it to our
patients to see how technology can allow
us to raise the bar. We can merge the
various technologies available that work
with the biology of the patient to deliver a
better and more predictable result.
For questions and more information,
Dr. Gardell can be reached at
drpeteg@aol.com.
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13
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11
12
Fig. 10: Flap reflected and osteotomy
performed.
Fig. 11: The implant carrier in position
Fig. 12: Final e.max custom abutment
Fig. 13: Surgical site at placement
Fig. 14: 1 week post-op
Fig. 15: Final restorations