Page 63 - CEREC Q4 | 2014

QUARTER 4 | 2014 | CERECDOCTORS.COM | 61
Baron Grutter
Yes. This was printed. The entire osteotomy
was guided. In fact, I used August’s ID keys so I
even contemplated placing the implant through the guide.
However,withher limitedopening, itwasn’t going tohappen.
Thanks.
Side note: you wouldn’t believe how well this guide fit. I
used Isolite, but in my poor planning, I only had the guide
go to the contra-lateral Lateral Incisor. Therefore, the bite-
block of the Isolite mouthpiece was not on it to secure it.
Didn’t matter. The thing snapped into place over and over.
I had to remove it almost every time to get my 18 mm drills
in. Yes, 18 mm short drills and it was still a tight squeeze
— actually they’re technically somewhere between 18-19,
depending on the handpiece you use. And this has more or
less been the casewith all the BSP guides. They fit verywell.
Baron Grutter
Here’s another. This is my first Molar Imme-
diate with a Bicon. The stability of these molar
implants is rather unique. However, I might argue that this
was even easier and more predictable than with threaded
implants. Why? Because rather than trying to keep a
threaded implant centered in the osteotomy and not acci-
dentallypress itself intooneof the root spaces, it ispassively
(though tightly) inserted directly into the prepared oste-
otomy with minimized lateral pressure that might cause
it to be deflected. Thus, those quasi-dehisences are not
really a concern for this type of insertion.
Here’s the plan
and some films.
Sorry, no pre-op
PA, since we had
the CBCT. So no
direct comparison.
You can see the
proximity of the
sinus and mesial
tilt of the tooth.
granulation tissue, finished osteotomy, curetted again since
I now had even better access, placed the implant (35+Ncm)
- 4.5 x 6 mm Conus 12, placed a cover screw, grafted the
sockets, replaced the cover screw with a 5 mm healing
abutment, grafted more, placed an OraPlug along the
2 mm lingual gap to tissue, and sutured it tight. The final
filmmakes it appear tilted to themesial. That’smore due to
the fact that the adjacent premolar is so buccal. That, and I
did favor the mesial direction during planning in consider-
ation of the sinus. The implant is pretty darn close to plan.
Ryan Michelson | Saginaw, Miss.
So when are you placing a membrane? It seems
like it varies. Would like to get intomolar imme-
diates and I wonder this every time I see these.
Baron Grutter
Personally, and somemay disagree, I rarely place
a membrane. Really, the only time I see a need
for a true membrane is when you have a fenestration, typi-
cally on the buccal. For molars, I just place themdeep, cover
them in FDBA, occasionally place a healing abutment, and
cover the graft with an Oraplug that is sutured down, tight.
Most often, I mix my graft with Methylcellulose (per the
teachings of Garg) and that helps to keep the bone in place.
The case I just posted today was actually my first in using
BSB’s larger healing abutments. I used it because I really
don’t want to go fishing for the cover screw in the future
with a bur. Plus, having the abutment allowed me to pack
more bone around the implant vertically without having to
actually cover the implant. Honestly, I’m not so sure about
the healing abutments in this size. I like to have the rounded
emergence that I’m used to with Bicon. I thought (in the
past) about taking a carbide to the underside and rounding
it, but didn’t on this case. Plus, I’d have to spend some real
time polishing it. I’m not sure why they are shaped so boxy.
Perhaps Sheldon will see this and chime in.
Does that help? Or was I simply rambling with no
purpose? I have a tendency to do that.
John Pappas | Phoenix
Was the guide printed? Did you do the entire
osteotomy guided or just the pilot?
Looks good!