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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
opinion _ 3-D technology I whichsubsidedforabout9monthsaftertreatment ofa6mmpocketwithArestin,alocalisedantibiotic. He returned on the 12th of December 2014 for reevaluation, where a periapical X-ray and perio- dontal probing of greater than 10 mm inter-radic- ularly was apparent (Fig. 41). This tooth had been previously treated with an endodontic therapy but now appeared to be failing. An enhanced radiographic CBCT scan was taken which revealed a huge infrabony lesion extending from the buccal plate through to the palatal wall (Figs. 42 & 43). The diagnosis was given of a hope- less tooth necessitating extraction and alveolar ridge regeneration in preparation for its future re- placement. The tooth was sectioned and removed in three pieces and the socket and alveolar ridge was bone grafted immediately post extraction. Healing was uneventful and the patient’s symp- toms were resolved. The follow up CBCT scan was obtained to pre- pare for a guided surgery, and as in the previous case I integrated a CEREC Omnicam optical im- pression with my GALILEOS data and planned for the placement of a Nobel Active 5 x 10 mm fixture. Youcannotehowwelltheboneregeneratedwhich made the placement of an implant possible. The use of an optical scan precludes the need for a stone cast and increases the accuracy by over- laying the dentition closely with the radiographic images when planning the restoratively driven implant. In this case, it was necessary to plan the placement to avoid entering the maxillary sinus. TheSICATsurgicalguidewasorderedandreturned to my office well in advance of the scheduled surgery (Fig. 44). The implant osteotomy was completed via a surgicalguideandtheimplanttorquedinat30Ncm and was monitored for integration. I placed a con- toured healing abutment to control soft tissue contours for a proper emergence profile. I utilised Nobel’s new 5.5 x 10 mm implant in this case as the regenerated ridge was wide enough to accommo- date this size fixture (Fig.45). The patient required no post-op pain medications and returned to normal immediately after the effects of the local anesthetic abated. The procedure was finished within 20 minutes, progressing at a comfortable pace that resulted in the uneventful post-op expe- rience for this patient (Figs. 46 & 47). Flapless guided implant surgery provides numerous ad- vantages, including preservation of circulation, decreased surgical time, improved patient comfort and accelerated healing. I 17CAD/CAM 1_2016 Fig. 44 Fig. 47Fig. 46Fig. 45 CAD0116_06-18_Ramirez 21.01.16 11:04 Seite 10 CAD0116_06-18_Ramirez 21.01.1611:04 Seite 10