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cone beam – international magazine of cone beam dentistry

special _ digital technologies I if it is going to be an open or closed procedure. We knowtheexacttypeandsizeofimplantandwhatsur- gical kit we will be using. Now we just have to order the surgical guide. In our practice we let In2Guide designandproduceourguides,sinceitisalaboratory atKaVothatdoesalltheworkunderstrictqualitycon- trol. We are confident in the precision and quality of theproduct.Ittakesabout7–10daysfromplacingthe order online until we receive the guide. We do not chargeourpatientsextraforthesurgicalguidessince thetimewesaveduringsurgerymorethancoversthe costsoftheguide.Andaftertheplacementoftheim- plantwealwayshaveanidealpositionoftheimplant in regards to the final prosthetic outcome. Placing a crown in harmony with the functional occlusion has improved the aesthetic results and reduced our prosthetic failure rate, including the amount of peri- implantitis. It is my belief that a lot of so-called peri- implantitis we see today is related to occlusal prob- lemsratherthanbiofilm.Butthatisatotallydifferent issue. Before doing any surgery, we need to think about a provisional restoration. The function of the provi- sional is primarily to prevent tooth migrations and to shape the soft tissue. This can be a fixed or a remov- ablesolution;directorindirect.Amongtheremovable solutions, we have the partial denture, the Essix re- tainer, bite splints with teeth mounted as provision- als, etc. (Figs. 5a-c). Among the fixed solutions there is the Maryland bridge and the immediate loaded implantcrown.Theimmediatecrownisusuallymade directly but can be made in advance utilizing the In2Guide software and the CAD/CAM team at KaVo. It requires a scanned model of the opposing arch and a bite registration (the two models held together). Onceagainwecanusealab-scannerortheconebeam scanner to acquire these data. This way we receive asurgicalguideandascrew-retainedprovisionalim- plant crown to be placed immediately after surgery. It is tricky but doable and removes the problem with bis-acrylics in the wound. The whole treatment planning protocol can seem alittleoverwhelming.Butinrealityitisfastandsaves a lot of chair time. The implant planning in In2Guide forasingleimplanttakesapproximatelyfiveminutes once you get accustomed to the software. Inourpractice,wehavebeenworkingwithsurgi- calguidessince2010.Theywereintroducedbecause wesawtoomanyimplantsplacedinalessthanideal prosthetic position. It was a problem faced with more than six different experienced surgeons. There seemed to be a paradigm among a lot of surgeons saying ‘We place the implants where the bone is’. In suchcases,wedonotwanttodothefinalprosthetic work because it will always be a compromise. Every step in implant surgery has to be planned andexecutedexquisitelywiththefinalprostheticso- lution in mind. It is the only way to a predictable and good result for the patient. Isn’t that what it is all about?_ I 17cone beam3_2015 Dr Jesper Hatt,DDS _Graduated fromAarhus University 2003. _Trauma surgery training in the Danish army. _Part time hands-on instruc- tor,Aarhus university surgical department 2005–2007. _Owner of private practice since 2007. _Post graduate education atThe Pankey Institute, FL,USA.250+ hours. _Pankey mentor since 2011. _International lecturer and hands-on instructor in ‘centric relation-based dentistry’ _Creator of a 4-day post-graduate hands-on train- ing programme in comprehensive dentistry 2012. _First Danish In2Guide user. cone beam_about the author Fig. 5b Fig. 5c

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