CAD/CAM Magazine

16 I I case report _ implant surgery As a team, we decided upon the final scenario. Restorative, surgical and laboratory issues were discussed and common conclusions decided. A Nobel Guide surgical guide was ordered through the software and subsequently produced via stere- olithographic rapid prototyping. The guide was toothbornewithonesurgicalpinincludedtoaidsta- bilisation (Fig. 5). Inspection windows were placed in the guide to ensure full seating during implant surgery. _Surgery: December 2006 The patient was anaesthetised using local an- aesthesia. The Procera Surgical Guide was placed, ensuringcompleteseatingusingtheinspectionwin- dows.Wedeterminedthatthepatienthadmaximum attached gingiva. A tissue punch was used through the guide, while it was held in place by finger pres- sure. The guide and the tissue plugs were removed. Then, the guide was replaced. The Nobel Biocare Guided Surgery protocol (Fig. 6) was followed, in- cluding placement of a stabilisation pin and use of a guided template abutment. After all three im- plants had been placed, the guide and any tissue tagspresentwereremoved,andhealingcapsplaced oneachimplant(Fig.7).Inaccordancewiththeplan, no temporary crowns were placed. Atfourmonths,astandardopen-trayimpression was taken to produce a mounted master model withagingivalmask.Stockabutmentswerechosen and modified by me and single-unit porcelain ve- neer crowns were constructed in the laboratory. At a secondary appointment, the healing caps were removed and the modified abutments placed and torqued (Fig. 8) according to the manufacturer’s specifications. The crowns were tried in, cemented and the occlusion adjusted (Fig. 9). _Discussion This case was not about the design and success ofimplantplacementprocedures,butaboutpatient management, using a team approach and a state- of-the-art technique (Nobel Guide) to achieve a patient’s desired request. At this point in dentistry, it can be agreed that implantsaresuccessful.Dentistsmustnotforgetthat they are treating patients and not teeth or implants. We must listen to our patients and figure out their desiresandneedsinordertoreallybesuccessful.Inthis instance,conventionalimplantdentistrymayhaveled to an open procedure with grafting of the sinus. By usingaguidedtechnique,implantsofmaximumlength were planned and placed, achieving the same goal, butmoreimportantly,respectingthepatient’sdesires. _Conclusion By adopting a team approach with a restorative dentist, oral surgeon and laboratory technician, we were able to design a biologically sound and sup- portive prosthesis. Using CBCT technology, we were abletomaximiseourdiagnosticskillsinordertoide- alise the surgical and restorative results. Using mini- mally invasive techniques, we were able to address the patient’s medical needs and desires by reducing theneedforantibioticsandopensurgicaltechniques. By looking at the placement of the implants in the post-operative CBCT (Fig. 10), the level of accu- racy was achieved with guided surgery. A 3.5-year follow-up appointment revealed optimal gingival and osseous health (Figs. 11 & 12). _Acknowledgments I would like to thank my team members Dr William E. Lippisch and Michael Hennessy of Hen- nessy Dental Laboratory for assisting me during all stages of the case._ CAD/CAM 2_2011 Dr Daniel J.Velinsky 800 SE Osceola Street,Suite B Stuart,FL 34994 USA office@drvelinsky.com CAD/CAM_contact Fig. 12Fig. 10 Fig. 10_Final CBCT of placement. Figs. 11 & 12_Images at 3.5 years. Fig. 11a Fig. 11b