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implants - international magazine of oral implantology

I clinical technique _ immediate restoration The surgical guide was placed in the patient’s mouth, and the tissue was punched utilizing a tissue punch (Figs. 6–8). Then, the surgical guide was again orientedinthepatient’smouthwiththeorientationjig created on the articulator and stabilized with three SurgiGuide fixation screws (Fig. 9). Utilizing the Zim- merGuidedSurgeryInstrumentationandGuidedSur- gery drills (Fig. 10), all eight osteotomies were created and completed using minimally invasive flapless sur- gery(Figs.11&12).TheZimmerguideisaSAFEsystem, accuratelyprovidingfordepthandsize. The right and left molar (teeth #3 and 14) os- teotomies were created short of the maxillary sinus. Then, using the new Sinus Crestal Approach Kit (Zim- mer),Iextendedthesetwoosteotomiesintotheleftand right maxillary sinuses. Alloplastic bone (Puros, Zim- mer) was placed into the sinus cavity through the os- teotomy and spread using the paddle-shaped spread- ing bur. Then, all eight implants were placed. Each had initialstabilityexceeding35Ncm.Idecidedtoimmedi- atelyloadonlythesiximplantsthatdidnotinvolvethe sinus cavity. Therefore, healing heads were placed on implants#3and14,andnon-engagingtitaniumtem- porary cylinders were placed on #5, 6, 8, 9, 11 and 12 (Fig. 13). The provisional, which the laboratory fabri- cated, was attached to the titanium cylinders using coldcureacrylic,thuscreatingascrew-retainedprovi- sional(Figs.14&15).Apost-operativeCTscanshowed how accurately the eight implants had been placed in the bone using a mucosa-supported SurgiGuide with orientation jig (made on the Immediate Smile model; Figs.16–18).Theaccuracyandsuccessofthiscasewas achievedthroughCTscanning,SimPlantplanningwith restorativemodeloverlay,theZimmerGuidedSurgery Instrumentation and the Immediate Smile model. The surgical guide allowed for minimally invasive surgery andgreatlyreducedsurgerytime.TheImmediateSmile modelalsoreducedchairtimebyallowingforfabrica- tionofthetemporarieswellinadvanceofsurgery._ Acknowledgement Laboratoryproceduresandphotographswerepro- videdbyDrMarceloSilvac/oDrMaxCohen. ThisarticlewasoriginallypublishedinImplantTribune Vol.6,No.4,April2011. 22 I implants3_2011 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Dr Max J.Cohen is in private practice in Dunwoody,Georgia,USA. E-mail:MaxJCohen@hotmail.com _contact implants