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24 I I case report _ guided implantology Milling time is approximately 12 to 16 minutes (Fig.16).Webreakthedrillbodyoutoftheblockand remove the sprue carefully. Next, we remove the reference body from the thermoplastic stent and, using a scalper or bur at a very low speed, cut away a thin layer of the ther- moplastic material from the bottom of the guide to allowthedrilltopassthroughtheguide.Whensnap- ping the drill body into the thermoplastic stent, it is important to ensure that the drill body is inserted with the correct vestibulo-oral orientation (Fig. 17). Sirona produces specific guide handles for each block size (again in small, medium and large) and for several implant guide kits. In our case, we used the guide handles for Straumann for the next step because these handles are compatible with the Implant Direct implant used. Surgery We begin with anesthetising the tissue around the work area and placing the cleaned and disin- fectedCERECGuideinthemouth,followedbythefit evaluation. The guide should feel secure and not move over the teeth. As we performed the flapless technique, we began by punching the tissue with theappropriatepuncher(Fig.18).Wethenremoved the guide and easily separated and removed the punchedtissue(Fig.19).WeplacedtheCERECGuide back into position and continued with subsequent drills and guide handles. UsingtheguidekitforStraumann(SironaCEREC Guide Drill Key Set ST), we started with the M 2.2 handle and 2.2 mm pilot drill (Fig. 20), followed by the M 2.8 handle and 2.8 mm drill (Fig. 21). Finally, we removed the CEREC Guide and inserted the 3.3/8 mm SwishPlus implant without the guide, that is, free hand (Fig. 22). Temporary We screwed a solid abutment (Implant Direct; Fig. 23) into the inner part of the implant, and cov- ered the screw-hole with Teflon. This was immedi- ately followed with an intra-oral scan. As scanning powder cannot be used for an unhealed soft-tissue margin, we used the new powder-free CEREC Omnicam camera. Next, we proceeded through the steps of CEREC Software 4.xx (Fig. 24) to mill the temporary crown from a LAVA Ultimate block (3M ESPE; Figs. 25 & 26). While it is acknowledged that dentistry is not Formula One, the patient was very satisfiedwithatotaltreatmenttimeof115minutes. _Conclusion This case report has demonstrated the work- flow and manufacture of CEREC guides. Anyone interested in this procedure and its processes is invited to visit our training centre in the Czech Republic, where one can view patient surgeries live andparticipateinapracticaldemonstrationcourse. For further details and course schedules, please visit www.gototraining.cz._ 1 Importantnote:Ifimmediatecastingofaplastermodel is not possible at your practice, it is possible to utilise a hydro-plastic stent material with a reference body of the correct size together with intra-oral scanning of the mouth to be placed directly in the mouth without astonemodel. CAD/CAM 2_2013 Fig. 25 Dr Josef Kunkela Czech Society of CAD/CAM Dentistry Růžová 41 CZ-37701 Jindřichův Hradec Czech Republic Tel.:+420 737 210 565 kunkela@dentalpoint.cz www.gototraining.cz CAD/CAM_contact Fig. 26