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ePaper created 2016-01-26, 09:24:16 | version 1.38.0
I case report _ digital workflow with guided surgery The drilling sequences were performed through the guide. To avoid bone overheating, high irri- gation was performed using the up and down drilling technique. Tapping and profile drilling were essential despite the maxillary soft bone. This is critical in order to follow all the steps nec- essary for correct implant positioning according to the planning. In order to maximise the preci- sion in the implant placement, we chose shorter implants than usual. This allowed us to achieve a quicker implant positioning through the surgical guide by using guiding transfer pieces that en- sured the final positioning (depth and angle). The implants were stabilised with a torque of 50 Ncm (Fig. 17). After removal of the surgical guide, the bone chips harvested during the drilling sequences were used to shape the crest and to fill the gaps. Interdental papillae were repositioned buccally by rotation. A conjunctive tissue graft was partially dis- sected from the palate while remaining pedicle in order to recreate the interdental papillae. Sutures helped to stabilise the gingivoplasty (Fig. 18). The screw-retained two-piece CAD/CAM bridge was finalised before surgery and immediately placed and screwed onto the three implants (Figs. 19–20). Slight tension was detected during the screwing, but with no consequences for the implants since they were not yet osseointegrated and the mechanical stress was too low. The only change to the temporary bridge consisted in slightly adapting the under-occlusion. Additionally, the SLActive surface stimulates the adsorption of blood proteins and enhances thefibrinnetworkformation,whichallowsforthe faster maturation of the bone. This is a major as- set in immediate implant placement after tooth extraction and in immediate aesthetics. Check- ups at 10 days post-op (Fig. 21) and at four weeks (Fig. 22) were used to verify correct gingival healing and implant integration. The postopera- tive courses were not painful and no oedema or haematoma was observed. _Results Immediateimplantplacementassociatedwith immediate loading is a predictable protocol with some variables. The digital tooth extraction was integrated with the production of a screw- retained CAD/CAM provisional restoration prior to the surgery and was successfully achieved and placed without any cementing steps in the dental practice. The entire treatment workflow wasdonefullydigitally.Onlyasinglesurgicalstep was required to provide an entire individualised prosthetic rehabilitation._ 28 I CAD/CAM 1_2016 Dr Sepehr Zarrine,DDS, oral surgeon.Exclusive private implantology practice (Saint Die,France).Speaker ITI France.European Master in Dental Implantology. Surgery,prosthetics,bone grafts (Frankfurt/Main, Germany).University diploma in surgical maxillofacial rehabilitation (Medicine,ParisVII). dr.zarrine@gmail.com surgitechstudies.com Jerome Vaysse,DT, Managing Director of the Laboratoire HTD (HighTech Dental) inToulouse,France. Member of the ITI and international instructor at the Straumann LabAcademy. Dental lab specialized in CAD/CAM,implantology,esthetics, and guided surgery (CoDiagnostix) contact@laboratoirehtd.com CAD/CAM_about the authors Fig. 21 Fig. 22 Fig. 20 CAD0116_24-28_Zarrine 21.01.16 10:50 Seite 4 CAD0116_24-28_Zarrine 21.01.1610:50 Seite 4