Page 64 - CEREC Q4 | 2014

62 | CERECDOCTORS.COM | QUARTER 4 | 2014
I will say there was one problem (which I don’t believe
will affect the outcome at all), and that was that I over-
looked a slight mis-alignment of the model to the scan.
This caused my planned implant to be slightly (~0.75 mm)
to the mesial of where I had intended. This should not
scare anyone away from BSP, as it was simply an oversight
on my end. I’ve had bad stiches with Optiguide, and that’s
why you always confirm it. However, in this case, I just
checked the cross-section, rather than the transverse view.
Withall that said, Inoticedthealignment issueshortlyafter
beginning. I considered grafting, closing up and returning at
a later date. Then, I considered the fact that she had pretty
much cried (anxiety and had not requested sedation prior to
beginning, and Imissed the signs during the consult) through
the entire extraction and so an additional surgerywouldpref-
erably be avoided, and that this placement would certainly be
a slam-dunk to restore, even if not perfect to plan. I hope you
all agree. So, I went ahead and completed the surgery.
Another reason I like Bicon for these cases is because I
was trained to place the implant at least as deep or deeper
than the furcation of the existing tooth to account for bone
loss and establish ideal emergence. That means that this
implant had to be quite deep. And with Bicon, that is stan-
dard protocol. So, I don’t worry.
As a note: some have asked if BSP can be used for
non-BSB implants. If you’ve read my posts, you probably
know that I place both Bicon and BSB implants as the
norm. I like them both for different indications. This case
is an excellent example that you CAN use another system
with BSP. In this case, I was able to obtain the necessary 5.0
mm Guided Kit sleeve that SiCat uses directly from Bicon.
I designed the guide, such that the sleeve only needed be
pressed in and it fit perfectly.
Lawrence Nalitt | Brooklyn, N.Y.
Baron, why no RCT?
Baron Grutter
Great question. I meant to elaborate on that.
I recommended that, actually. However, she’s
20 years old and has the worst dental anxiety I’ve ever
treated. I explained that we would have to do a RC and
remove some soft tissue (the depth of decay was approxi-
mately 3 mm sub-g) and likely a little bone. Not much, but
BCL would have been needed. She and her mother were
| | | D I S C U S S I O N F O R U M
shaking their heads from the moment I mentioned root
canal. They wanted an implant and I really couldn’t refuse.
No question saving the tooth would have been possible,
but not the best prognosis. So, I obliged.
Thomas Kauffman
Wow. That decision to remove that tooth is
concerning at the very least. I would not have
complied with that request.
Baron Grutter
As I said, could this tooth have been saved? Yes.
Would it have required BCL? Yes, unless I was
going to leave absolutely zero biologic width and let the
body do the work for me over a period of chronic inflam-
mation. However, it really doesn’t matter too much when
the patient refused RCT.
In my practice, when a patient who is in pain has a tooth
that requires either RCTor TE, I don’t tell them“tough luck”
if they deny the RC. It’s not my tooth. If they don’t want an
RC, fine. I’mnot going to lose sleepover it. In fact, that’spretty
common. Most often, it’s because they feel they can’t afford
theRCT. And sometimes, it’s because they’ve had bad experi-
enceswithRCT in the past.With this young lady, she had her
own personal reasons. I didmy best to dismantle them. I told
her if it were my tooth, there’s no doubt that I would first try
to save it. But in the end, shemade the choice to get it out.
Let’s face it, implant dentistry can present a fun challenge.
However, it’s by far the most expensive service I offer with
regard to my own overhead. I would have charged almost
the same exact thing for the RCT/BU/BCL/Cr as I do for
the Implant/Abutment/Cr. And, it wouldhave takenme less
treatment time (planning, surgery, restoring), would have
been completed much sooner and my material overhead
would have only been around $50-60; whereas the surgery
materials will be closer to $500-600. From a practice
perspective, it’s much better to save the tooth. But, I can’t
very well strap the patient down and force her. And denying
her any treatment really doesn’t make sense to me, either.
Sorry we don’t see eye-to-eye on this.
Anthony Kraft | Seymour, Wis.
I agreewithBaron on this one.We all wouldhave
wanted to save this tooth, but in the end, wemust