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Dental Tribune United Kingdom Edition

November 14-20, 2011United Kingdom Edition22 Implant Tribune page 21DTß About the author Dr Max J. Cohen is in private prac- tice in Dunwoody, Georgia, USA. E-mail: MaxJCo- hen@hotmail.com © MIS Corporation. All Rights Reserved. The MIS SEVEN implant has a highly advanced surface with a high rate of successful osseointegration (98%), which was validated by extensiveworldwideresearchandclinicalstudies in cooperation with world-class universities and scientificresearchinstitutes.Itsuniquegeometrical design gives the SEVEN implant the important features of simple, quick and safe insertion, high primary stability, and compatibility in the most complex cases in every area of the jaw. Simplicity is The Key to Success Innovation Movement by MIS... INNOVATION The MIS SEVEN implant is the only implant system in the world that comes with a specially designed and sterilized final drill, allowing a short and safe drilling procedure. MIS makes it simple with SEVEN implant. The only implant in the world that comes with a specially designed and sterilized, single use, final drill, allowing a short and safe drilling procedure. To learn more about MIS visit our website: www.mis-implants.com or call us: 01255 424624 M a k e i t S i m p l e UK ® ® allowed me to recover the ana- logues. The silicone soft tis- sue on the model also corre- sponded to realistic soft tissue. I also received written drilling instructions and a prolongation report detailing the depth and size of each osteotomy. Zimmer analogues were placed in the Immediate Smile model (Fig 3). The duplicate of the scan pros- thesis was used to mount the bone model with the soft tissue on an articulator (Fig 4), giving correct orientation and vertical dimension. This made it possible to fab- ricate a provisional that would be used for immediate loading following implant placement. The mounted model was then used to create an orientation jig for the SurgiGuide (Fig 5). The jig assured that the SurgiGuide was positioned in the mouth ex- actly the same way as the scan prosthesis had been positioned in the mouth. This is a very im- portant step for a mucosa-sup- ported SurgiGuide because of the flexibility of the soft tissue (mucosa). Both the duplicate of the prosthesis and SurgiGuide fit perfectly onto the Immediate Smile model, allowing for fab- rication of an accurate orienta- tion jig on an articulator. 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 oriented in the patient’s mouth with the orientation jig created on the articulator and stabilised with three SurgiGuide fixa- tion screws (Fig 9). Utilising the Zimmer Guided Surgery Instrumentation and Guided Surgery drills (Fig 10), all eight osteotomies were created and completed using minimally in- vasive flapless surgery (Figs 11 & 12). The Zimmer guide is a SAFE system, accurately providing for depth and size. The right and left molar (teeth #3 and 14) osteotomies were created short of the maxillary sinus. Then, using the new Sinus Crestal Ap- proach Kit (Zimmer), I extend- ed these two osteotomies into the left and right maxillary si- nuses. Alloplastic bone (Puros, Zimmer) was placed into the sinus cavity through the os- teotomy and spread using the paddle-shaped spreading bur. Then, all eight implants were placed. Each had initial stabil- ity exceeding 35Ncm. I decided to immediately load only the six implants that did not involve the sinus cavity. Therefore, healing heads were placed on implants #3 and 14, and non- engaging titanium temporary cylinders were placed on #5, 6, 8, 9, 11 and 12 (Fig 13). The provisional, which the labora- tory fabricated, was attached to the titanium cylinders using cold cure acrylic, thus creating a screw-retained provisional (Figs 14 & 15). A post-operative CT scan showed how accu- rately the eight implants had been placed in the bone using a mucosa-supported SurgiGu- ide with orientation jig (made on the Immediate Smile mod- el; Figs 16–18). The accuracy and success of this case was achieved through CT scan- ning, SimPlant planning with restorative model overlay, the Zimmer Guided Surgery In- strumentation and the Immedi- ate Smile model. The surgical guide allowed for minimally invasive surgery and greatly re- duced surgery time. The Imme- diate Smile model also reduced chair time by allowing for fab- rication of the temporaries well in advance of surgery. DT Acknowledgement Laboratory procedures and photographs were provided by Dr Marcelo Silva c/o Dr Max Cohen. This article was origi- nally published in Implant Trib- une Vol. 6, No. 4, April 2011. ‘I decided to imme- diately load only the six implants that did not involve the sinus cavity’