Dental Tribune United Kingdom Edition

Guided implant surgical placement with Cad/CAM CEREC Crown Nilesh R Parmar presents a surgical case study Implant Tribune pages 15-17 An interview with Dr Steven Bongard Fixed teeth in a day Implant Tribune pages 18-20 Armin Nedjat argues the case Short Implant Placement Implant Tribune pages 21-23 Amit Patel discusses a recent technology in implant surgery Laser-lok Implant Tribune G uided surgery has been around for a long time. However, very few dentists in the UK are placing implants via the use of a guided surgical procedure. The reasons for this are multi- ple, ranging from dentists not wanting to, or not having con- fidence in the procedures, the increased costs of guide fabri- cation and the time delay and extra appointments needed to obtain a fully working and re- liable surgical guide. In this case study I shall be demonstrating an in-house manufactured surgical guide using the CEREC AC BluCam. These guides do not require any impressions to be sent to a third party and can be made rather cheaply in the surgery within around 30 minutes. The guide can then be used in conjunction with specific drill keys, which are compatible with the guided surgical drill sets from all leading implant manufacturers. In this partic- ular case the Astra/Dentsply Implants Facilitate system was used to place the implant. Once the implant was osse- ointegrated the final restora- tion was fabricated chairside using the CEREC milling ma- chine and an Ivoclar Vivadent e.max block. Case Study This young lady had lost her LL6 a few years ago and wanted an implant solution. Her medical history was clear and she had a mildly restored dentition with no current den- tal pathology. Her BPE scores were low, with excellent oral hygiene. The patient was scanned using the Sirona AC BluCam and a proposal for the miss- ing LL6 was created. A Gali- leos collimated lower jaw CBCT scan was taken with a CEREC Guide reference body set in thermoplastic over the edentulous area. The refer- ence body is identified within the software and a virtual im- plant placement along with the CEREC crown proposal is all imported into the soft- ware. This allows the clini- cian to virtually place the im- plant, with reference to the ideal final crown position. In this case, it was deemed that a screw-retained restoration would be desirable; hence the screw access hole was posi- tioned through the centre of the crown. Once the implant position was decided, the information is ported over into the CEREC software and using a CEREC Guide Mill Block a drill body is milled by the MCXL mill- ing machine. Once this has been milled it will lock tightly into the thermoplastic drilling template. The surgical guide is now complete and can be used on the patient. In this particular case an Astra 4.0 x 11mm TX implant was placed using the surgical guide. The patient is prepared using a standard sterile proto- col and the area anaesthetised as one would for a regular page 12DTà Fig 1. Reference body with cerec guide mill block Fig 2: Thermoplastic warmed in hot water and placed over the working model Fig 3: Reference body and thermoplastic surgical guide