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CAD/CAM - international magazine of digital dentistry

Fig. 6_Pre-op occlusal view of the maxilla. Fig. 7_Tissue punch. Fig. 8_View of the punched maxilla after tissue removal. Fig. 9_SurgiGuide orientation in the patient’s mouth. Figs. 10 & 11_Creating guided osteotomies. Fig. 12_Occlusal view of the implants and abutments. Note the healing heads on the two implants with sinus lifts. I 07 case report _ implant placement I cad/cam 3_2011 Using SimPlant, the optimum implant positions weredetermined,baseduponavailablebone,amin- imum of 3 mm between implants, and the design of the final restoration (Figs. 2a & b). The resulting treatmentplanwassubmittedtoMaterialiseDental for fabrication of a SurgiGuide and an Immediate Smile model. I received the Immediate Smile model, which containedaduplicateofthescanprosthesis,abone modelwithasiliconesofttissue,andamucosa-sup- portedSurgiGuide.Thebonemodelcamewitheight openings corresponding to each of the eight im- plantpositionsasdesignedintheSimPlantplanand corresponding exactly in size to the dimensions of Zimmer analogues. The bone model came with a screw fixation sys- tem, which allowed me to recover the analogues. The silicone soft tissue on the model also corre- sponded to realistic soft tissue. I also received writ- ten drilling instructions and a prolongation report detailing the depth and size of each osteotomy. ZimmeranalogueswereplacedintheImmediate 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 fabricate 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 exactly the same way as the scan prosthesis had been positioned in the mouth. This is a very im- portant step for a mucosa-supported SurgiGuide becauseoftheflexibilityofthesofttissue(mucosa). BoththeduplicateoftheprosthesisandSurgiGuide fit perfectly onto the Immediate Smile model, al- Fig. 11Fig. 10 Fig. 9Fig. 8 Fig. 7Fig. 6 Fig. 12