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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
case study _ backward planning I could be placed without creating a flap (Fig. 7). The next step was introduction of the initial drill. This removed the previously pierced soft tissue fully and ensured exact predrilling, as the tip of this drill is designed to avoid drifting off course even when it meets an oblique bone level (Fig. 8). When drilling into the bone, the maximum speed of 1,500 rpm was not exceeded, and saline solution was used for external cooling. Bone heating can be avoided, and a pump effect to remove bone tissue efficiently can be generated by an intermittent drilling technique. The evolution of the new system is also apparent in the sharpness of the drills. The very dense bone in this case, where immediate restoration was planned, could be prepared without pressure and therefore without any risk of bone necrosis. Preparation was continued with ASTRA TECH Implant System EV/GS no. 1 and no. 3 drills. These have a depth stop that prevents too deep drilling preparation, and they can be used for preparation of two different implant lengths. This is enabled by positioning the sleeve at a different height or depth in the template, depending on the implant length (Figs. 9 & 10). The conical A/B drill is then used to preparetheboneinthecrestalregion.Thisdrilldoes not have a depth stop like the other instruments but has laser markings on the shaft. The surgeon can thus use the bone quality to control the desired preparation depth (Fig. 11). Surgicaltray The completely redesigned surgical tray leads intuitively through the sequence of drills and comprises all the information necessary for using the components. During implant placement, it is ensured that the depth markings on the placement instrumentareatthesamelevelwiththeSafeGuide in accordance with the implant lengths. Since an ATLANTIS Abutment produced prior to the surgical procedure was used in this case, a further unique feature should be noted: the placement instrument has six cams, one of which is bigger and deeper than the other five; this cam must be exactly in line with the groove in the guide. This guarantees cor- rect alignment of the implant, which ensures one- position-only placement of the abutment and thus an exact fit of the abutment and temporary crown (Fig.12).Thisuniqueinterplayofhardwareandsoft- wareenablesuseoftheImmediateSmileconceptfor single-toothrestorations,distinguishingSIMPLANT from other guided surgery systems (Figs. 13 &14). Aftertakingacontrolradiograph,thetemporary crown was connected to the abutment. The course of the actual treatment session was very structured and straightforward because of the precise pre- liminary work and template-guided im- plantplacement.The patientlefttheoffice with an immediate implant-supported restoration (Fig. 15). _Conclusion For backward planning, with spec- ification of the pros- thetic objective to implant positioning, digital possibilities are in- creasingly an asset for the treatment team. These include guided implant placement, which ensures efficient and precise implementation of the plan- ning. With innovative treatment concepts such as the Immediate Smile concept and ATLANTIS Abut- ment, the digital planning components can be combined in one project file. Only one data set is needed, from the virtual elaboration of the set-up through three-dimensional diagnosis of the avail- able bone and planning of the implant position to construction of the patient’s custom abutment and CAD/CAM fabrication of the temporary re- storation. Due to the template-guided implant placement and gradual preparation of the implant bed, the implant position that was planned three-dimen- sionally can be transferred precisely to the mouth with relatively little effort. If the necessary primary stability is achieved, immediate restoration can be carried out with a patient-specific abutment (ATLANTIS) and temporary crown. This results in a simplified procedure for implant-based imme- diate restoration of a single-tooth gap. Backward planning using coordinated hardware and soft- ware is an important part of implant-based treat- ment concepts in daily work, enabling the primary benefit of immediate restoration—a significant shortening of treatment time—to be optimally exploited._ Fig. 15_Provisional restoration. I 23CAD/CAM 1_2016 Dr Christian Mertens,DDS Heidelberg,Germany christian.mertens@ med.uni-heidelberg.de CAD/CAM_contact Fig. 15 CAD0116_20-23_Mertens 21.01.16 10:49 Seite 4 CAD0116_20-23_Mertens 21.01.1610:49 Seite 4