CAD/CAM Magazine

Fig. 5_Procera Guide. Fig. 6_Implant placement using guide. Fig. 7_Healing caps. Fig. 8_Abutments torqued in place. Fig. 9_Crowns at time of cementation. I 15 case report _ implant surgery I CAD/CAM 2_2011 _Secondary presentation: August 2006 The patient was re-examined this time with guided implant surgery in mind. She stated that shewouldacceptsurgeryifitcouldbedonewithout antibiotics. We conceived a team approach that included me (restorative dentist), Dr William E. Lip- pisch (oral surgeon) and dental technician Michael Hennessy. _Treatment goal The patient’s treatment goal was to have poste- rior teeth that would enable her to chew. Further- more, she wanted treatment performed without the use of systemic antibiotics. Our team’s goal included a treatment plan that would result in inte- grated implants, restored with single, non-splinted crowns, performed with a flapless, minimally in- vasive guided surgical technique. We planned a one-stage approach without temporisation. The patient agreed to one preoperative antibiotic dose of 2,000 mg amoxicillin and a five-day course of Peridex oral rinse. _Scan-guide construction An appointment was set up and a polyvinyl- siloxane impression of her upper arch, a polyvinyl- siloxane bite registration and an impression of the lower arch were taken. Models were mounted and a wax-up constructed, giving ideal placement of future implants for area #2, 3 and 4. From this wax-up, a scan guide (Fig. 1) was constructed with implants for area #2, 3 and 4, according to the Nobel Biocare design. Gutta-percha markers were placed in the guide for the dual-scan technique. A flange was designed to hold the prospective anchor pin. Inspection windows were produced in the guide to ensure its proper and complete seating in the mouth. This is paramount for a proper relationship of the radiographic guide to the present dentition in the CBCT scan, which helps to verify that the laboratory-fabricated surgical guide was properly seated in the mouth during the surgical phase. PriortotheCBCT,apolyvinyl-siloxanebite(Fig.2) was taken with the scan guide in place to be used during the CBCT and for subsequent mounting of thecaseonasemi-adjustablearticulator.Thiswould then replicate the surgical plan. _Surgical-guide fabrication A CBCT scan was taken using Nobel Biocare’s ‘double scan’ technique. This allowed for a combi- nation of the radiographic scan guide to the pa- tient’s Dicom CT information in the Nobel Guide Software. A virtual surgery was performed with the Nobel Guide Software (Figs. 3 & 4). We decided that implants could be placed in such a manner as to avoid the sinus lift and augmentation. Fig. 9 Fig. 7Fig. 6Fig. 5 Fig. 8