CAD/CAM - international magazine of digital dentistry

18 I I case report _ guided surgery Afterwards,thepreparationoftheimplantbedis made, successively using specialized guiding tools and corresponding spiral drills that could clinically be inserted into the slots of the sleeves. A flapless approach is only recommended if the local bone anatomy is adequate in volume, and if a wide band of keratinized mucosa is present at the implant site (Figs. 6a & b). An implant depth gauge is placed after the first drilling to confirm accurate positioning of the osteotomy. Early error detection can be noticed at thisinitialstageandapossibledeviationofthepro- posedimplantpositionmustbecorrectedmanually (Figs. 7a & b). Afterwards,theguideddrillsequencecanthenbe continued.Thepresentbonedensitywilldetermine, ifthreadcuttingisnecessary,ornot(Figs.8a–c).The placement of up to RN/RC-diameter-implants can be made directly, guided via the integrated 5 mm drill sleeve. Implants with larger diameters must be inserted manually by guidance of the finalized drill bed. The post-operative radiograph shows the correct prosthetic positioning of the implant with sufficientsafetydistancefromtheNervusalveolaris interior and the adjacent dentition (Figs. 9a–c). _Prosthodontics Step4 Based on an additional intraoral optical im- pression using an implant scanbody, a second STL file can be created immediately after implant placement. This STL file is then also implemented into CoDiagnostiX. Differences between the actual implant location and the virtually planned position can be correlated and compared (Figs. 10a–c). Moreover, the implant-supported prosthetic suprastructurecanbedesignedandfabricateddur- ingthehealingperiod.Allthenecessaryinformation of the actual implant position is still included in CAD/CAM 4_2013 Fig. 7a Fig. 9b Fig. 9cFig. 9a Fig. 8b Fig. 8cFig. 8a Fig. 7b