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today EAO Stockholm 24 September 2015

science & practice16 EAO Annual Scientific Congress 2015 · 24 September Having the ability to take a pa- tient from point A to point Z in fewer appointments within one’s practiceallowsonetopositionone- self as a provider that can fulfil pa- tient’s surgical and restorative needs. With the proper training, a dental provider may provide ex- traction, grafting and implant placement within one appoint- ment at one location. Not only does this allow the reduction of the numberofvisitsforthepatient,but this type of service also helps the patient stay within his or her budget. Most importantly, this en- ables the dental provider full con- trol of the surgical and prosthetic outcome. Depending on the patient’s de- sires, the clinical conditions of the oral environment and the skills of the dentist, the dentist may choose to extract teeth, level bone, and graft with simultaneous dental im- plant placement. In this case, a pa- tientinhismid-sixtiespresentedto theofficewithdiscomfortowingto multiplerampantcariesandgener- alised advanced periodontal dis- ease (Figs. 1 & 2). Having already visited multiple providers for a consultation, he was very frus- trated with the treatment options offered with varying treatment plansthatweresegmentedintodif- ferent disciplines. Since many of these options did not complement the other, the patient decided to come to us for full treatment after being referred by one of our pa- tients who had undergone a Total Dental Solutions Reconstruction. Before the surgical appoint- ment, a CBCT scan was taken to ac- curately plan treatment for this case to make certain that no com- plications would arise from com- pleting all of the procedures (ex- tract,graftandimplantplacement) intheTotalDentalSolutionsRecon- struction protocol. CoDiagnostiX software (Dental Wings) was used through 3D Diagnostix virtual as- sistancetopreciselyplantheplace- ment of six Engage (OCO Biomed- ical) dental implants in the maxil- lary arch, as well as seven Engage dental implants in the mandibular arch using CT-based surgical pilot guides (3D Diagnostix; Figs. 3 & 4). The final treatment plan was fixed bridges on implants in the maxillary and mandibular arches. Engage implants were selected (Fig. 5) because I have personally experienced their high implant stability at placement, which is a critical success factor during the early healing process of osseointe- gration with these types of cases. With the combination of its patent- pending Bull Nose Auger tip and Mini Cortic-O Thread, this implant system offers practitioners a bone- level implant with high initial sta- bility for selective loading options. In fact, the Engage implant body creates a tapping pattern when threadedforanenhancedmechan- ical lock in the bone. Other dental implant systems with aggressive threading may include, but are not limited to, NobelActive (Nobel Bio- care), SEVEN (MIS Implants Tech- nologies), ET III (Hiossen), I5 (AB Dental) and AnyRidge (Megagen). For effectiveness and greater proficiencyduringtheTotalDental Solutions Reconstruction proce- dures, intravenous sedation should be performed. Not only does it make the appointment eas- ier, but patients also prefer to have the treatment completed in one visit. Since the patient is sedated, a mouthpropisneededtokeephisor her mouth open. Because of this, teeth are extracted in quadrants, starting from the upper left to the upper right and then down to the lower right and lower left. This al- lowsgreattime-savings,asitiseas- ier to keep the patient’s mouth open and be able to proceed around the arches safely. Once the teeth have been extracted, the tis- sue has to be reflected in order to seat the bone-level surgical guides and fix them with their respective retention pins. Using these pilot surgicalguides,theosteotomiesfor Efficiently delivering full-mouth reconstructions By DrAra Nazarian,USA Fig. 1: Retracted pre-op view. Fig. 2: Pre-op panoramic radiograph. Fig. 3: Maxillary virtual treatment plan. Fig. 4: Mandibularvirtualtreatmentplan. Fig.5:Engagedentalimplant. Fig.6:Asepticosurgicalmotor. Fig.7:Usingthepi- lot guide. Fig. 8: Osstell ISQ unit. Fig. 9: Good Fit Instant Custom Tray. Fig. 10: Full-arch impression. Fig. 11: Post-op panoramic radiograph. Fig. 12: Retracted post-op view. 2 3 4 5 6 7 8 9 10 11 Dr Ara Nazarian 12 1 2345 6789 1011

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