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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
I opinion _ 3-D technology Nobel Active (Nobel Biocare) implants were in- stalled as planned. The #31 site was completed with a flapless ap- proach but I wanted to examine the #28 site to be certain that my preparation was indeed perfectly accomplished. The #30 site required a flap to move the keratinised tissue from the lingual to the buc- cal. So the #28 and 30 implants required mini flaps and were second staged, which later required uncovering to access the platform during the im- pression procedure. The surgery went well and the patienttoleratedthe1hourvisitwithoutincidence. He commented post-operatively that he experi- enced no pain and did not realise how uncompli- cated this treatment could be. He was able to re- sume all normal activities immediately without any restrictions. My years of experience have given me the necessary skills to manage these patients and their surgeries in a quick, minimally traumatic approach resulting in less post-operative prob- lems and faster healing times versus conventional wide flap implant surgeries. Note how the plan and the actual match up well in my periapical x-rays (Fig. 11). We allowed the necessary time for these im- plants to integrate uneventfully and he presented for a fixture level impression which began the restorative phase of treatment (Fig. 12). In addition Iplacedprovisionalabutmentsandfabricatedanin office 4-unit provisional bridge out of Luxatemp bisacrylic (DMG) and dismissed the patient with a very light occlusion and instructions to slowly introduce varying food densities which would be- gin placing strain on his implants. Dental labora- tory fabricated custom abutments and a metal framework which was tried in and accepted for use as the definitive fixed bridge. A well-fitting and lightly occluding natural looking fixed bridge was inserted on the 13th of May 2014. This phase of treatment concluded with a very happy patient whosedentitionwasmadewholebyaverypositive implant experience (Figs. 13 & 14). Onemayquestion,isasurgicalguidenecessary? In my practice it is the standard. For the well experienced specialist maybe not, but for the general practitioner or less experienced specialist absolutely yes. It ensures predictability, safety, and decreases the possibility of injury to our patient. Success was achieved on so many levels. First, we managed the patient’s anxieties with a positive implant experience and without any post-opera- tive complication and no untoward reaction. Sec- ondly, my patient was returned to a full comple- mentofteeththatshouldbelonglasting.Third,the 4-unit restoration blended in with his remaining natural dentition and his occlusion was controlled byreducingbuccallingualdimensionsandcreating light centric stops with no lateral excursion pre- maturity. Fourth, resultant keratinised tissue was present,withoutpostopbleeding,swellingorpain. Finally,thishappygratefulpatientwasmadewhole as the treatment went as effortlessly as planned. The next three cases can be grouped together as they all have a commonality to them. Each patient presented with mild discomfort and two ofthethreewereseenbyotherdentists,whoeither refused treatment or never diagnosed a problem. All three were handled similarly in my office. The conventional documentation and diagnostic 12 I CAD/CAM 1_2016 Fig. 23 Fig. 24 Fig. 20 Fig. 21 Fig. 25 Fig. 22 CAD0116_06-18_Ramirez 21.01.16 11:03 Seite 6 CAD0116_06-18_Ramirez 21.01.1611:03 Seite 6