cone beam CE

cone beam1_2012 case study _ anterior mandible I Fig. 3_ Maximum Intensity Projection Sirona Galileos. Fig. 4_ A CBCT with a Cerec Blu- Cam overlay showing the ideal final result. Fig. 5_ Stage 1 implant placement with healing abutments in place. Figs. 6, 7_ Presentation at eight weeks. I 27 form of replacement was necessary. The patient did not want a removable restoration and preferred a fixed solution. In this area of the mouth either fixed bridgework or an implant-retained prosthesis were possible. Afterlearningabouttheoptions,andwiththeun- derstanding of the increased risk of peri-implantitis of implants in patients with previous periodontal disease, (Esposito 2006) the patient opted for a fixed implant-retained solution. The treatment was to be planned in such a way thatifshelostherposteriormolarsinthefuture,afull archfixedprosthesiscouldbemadeaftersubsequent implant placement. _Treatment plan Step 1: Continuation of periodontal treatment and oral hygiene advice. Step 2: CBCT Sirona Galileos scan to assess bone height, bone profile and associated anatomy. Step 3: Extraction of all four lower incisors and the UR4. Step 4: Placement of two Straumann SLA active implants. Step 5: Restoration with a screw-retained four- unit PFM bridge. _CBCT It was decided to take a full volume CBCT to fur- ther assess the upper teeth and the UR4 for future implant replacement. The CBCT showed excessive bone loss around the anterior incisors with a small area of periapical radiolucency around the LL1. A cross-sectional view showed thick, well-developed cortical plates with very little lingual concavity. Due tothegoodboneheightandminimalpathology,im- mediate implant placement was planned. Due to the patients bone loss, the lower incisors had drifted, giving a less than desirable tooth posi- tion. Among the patient’s main complaints were the gaps that had appeared between the lower incisors and the uneven appearance of the incisal edges. To aid implant placement in the correct angula- tion, a CEREC Blu-Cam image was taken and ma- nipulated so that the lower tooth positions were in harmonywiththerestofthedentition.Thisproposal was then overlaid onto the CBCT scan and was used tofacilitateimplantplanning.Theaimwastoprovide thepatientwithascrew-retainedbridgewithaccess holesthoughthelingualaspectsofthelowerincisors, whilstmaintainingasoundmarginofsafetyfromthe lingual cortical plate. Due to the patient’s previous periodontal his- tory, it was decided to use Straumann Standard Plus implants in this case. The design of this implant in- corporates a 1.8 mm polished collar above the active surfaceoftheimplant.Thisresultsintheimplant-to- abutment junction being located 1.8 mm superiorly to the bone crest. _Surgical procedure The patient was given 400 mg ibuprofen and a Chlorhexidinemouthrinsebeforethesurgerybegan. Fig. 3 Fig. 5 Fig. 6 Fig. 7 Fig. 4