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cone beam CE

cone beam1_2012 Figs. 8, 9_Laboratory made screw-retained porcelain bridge on Straumann Sync Octa abutments. Fig. 10_The bridge. Fig. 11_ Appearance at fit. Fig. 12_Pre-op presentation. Fig. 13_CBCT with CEREC integration. I case study _ anterior mandible 28 I The procedure was carried out under intravenous sedation using Midazolam. The lower incisors were removed using periotomes and forceps. The sockets were curetted and thoroughly irrigated. A crestal incisionwithdistalrelievingincisionswasmade.Due to the CBCT and surgical stent, only a small lingual reflection was necessary. Implant placement was carried out using stand- ard ITI protocols. Two Straumann SLA-Active Stand- ard Plus implants of 4.1 x 10 mm were placed. The implantsexhibitedexcellentprimarystabilitywithan insertiontorqueofgreaterthan35Ncm.Thepatient’s bonequalitywasestimatedtobetypeD1-2(Lekholm abd Zarb 1985). Due to the high primary stability and good bone quality, it was decided to adopt a single-stage surgi- calprotocol,therebyplacinghealingabutmentsover the implants. The site was closed using 5.0 PGA sutures and a toothsupporteddenturereplacingthelowerincisors was fitted. Careful examination of the denture was carriedouttoensuretherewasnocontact,ortransfer of occlusal load onto the implants from the denture. The patient was seen seven days after surgery for suture removal and review. The patient healed without incident and due to the favourable lingual undercuts of the lower teeth was able to comfortably wear the denture during the healing process. Due to financial reasons, the planned implant placement for the UR4 site was deferred until a later date. After eight weeks of healing, fixture level open- tray impressionsweretakeninImpregum(3MESPE), and a four-unit screw-retained bridge was fabri- cated.Thetoothsetofthedenturewasduplicatedon the final bridge because the patient was happy with the tooth size and shape. Due to the previous bone loss, pink porcelain was added to the bridge to im- prove the emergence and reduce the crown lengths of the lower incisors. Thebridgewasseatedandtorquedto35Ncmand compositeplacedintheaccessholes;abaselinelong cone periapical radiograph was taken to serve as a baseline for bone-level measurements. The occlusion was checked, with the patient ex- hibiting canine guidance in excursive movements. Thepatientwasshownhowtocleanunderthebridge using super floss and tepe brushes and placed on a long-term maintenance programme. _Prognosis The bridge has a good long-term prognosis be- cause this patient is highly motivated and exhibits Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 ‘CBCT has helped plan, simplify and execute implant placement in the anterior mandible.’