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QUARTER 4 | 2014 | CERECDOCTORS.COM | 5
holding the teeth in. This will reduce
the amount of trauma to the buccal
plate, which in turn reduces the risk of
facial bone recession.
After the removal of the teeth was
accomplished, the surgical guide was
tried in (Fig. 6). The initial osteotomy
is performed in one of the more ante-
rior sites (Fig. 7). This will allow for a
tripod stabilization of the surgical guide.
The one problem with large spans of
missing teeth is the stability of the guide
during surgery. Any amount of micro
movement can cause deviations from
the planned placement. The Straumann
guided surgical kit has a good solution
to this problem. Within the guided kit
are stabilization pins that are placed in
the initial osteotomy through the guide
(Fig. 8). This creates a purchase point
for the guide to be stable while the rest
of the osteotomies are created without
concern for micro movements.
The osteotomies are then completed
utilizing the key system that is in the
Straumann guided surgical kit. After the
sequence is done, the guide is removed
and the osteotomies are evaluated to
see if the placement is correct with
regard to the facial plate. In imme-
diate extraction and placement cases,
the implant should be placed slightly
below the facial crest of bone to account
for the loss of the facial plate. One mm
is generally good to accommodate. In
most cases, for restoration you want the
top of the implant to be at least 3 mm
away from the restorative margin. You
will need to place the implant slightly
subcrestal to achieve this. This is espe-
cially important if you are going to
utilize the Sirona TiBase system.
Once the osteotomies are finalized,
the crestal bone is profiled to prevent
binding of the implant (Fig. 9). The
implants are all placed to 30+ ncm of
torque. This is done free hand instead
of through the guide since I need to
see exactly where the implant ends
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6
8
10
9
7
11
Galileo’s. Final implant placement based
on the final restorative outcome was
then diagnosed (Fig. 4). Implants were
planned for the #6, #8, #9 and #11 loca-
tions, with two fixed partial dentures
for final restorations. This file was then
uploaded to Sicat and used to fabricate
an Optiguide.
The patient presented day of surgery
having been on 500 mg of amoxicillin
tid and Peridex rinse bid for three
days. This regime will be continued for
seven days post-surgery as well. The
six anterior teeth were removed using
periotomes and forceps with minimal
to no luxation (Fig. 5.) The advantage
we have in this case is the lack of bone