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ePaper created 2016-03-02, 11:52:18 | version 1.38.0
By Siamak Abai, DDS, MMedSc n When treatment planning den- tal implant therapy, one of the big- gest questions practitioners face is whethertoemployfreehandorguided surgery. Exploring the advantages and disadvantages of each approach via case examples can help clinicians arrive at an informed decision. Case example No. 1: Freehand implant placement A 54-year-old female with an exist- ing implant in the area of tooth #30 presented with pain in the area of the implant, stock abutment and crown. Intraoral and radiographic examination revealed a significant amount of crestal bone loss and soft- tissue inflammation surrounding the implant. This was likely the result of residual excess cement. To avoid such complications, custom implant abut- ments or screw-retained crowns are recommended. A treatment plan was proposed in which the patient’s existing implant would be removed, a bone augmen- tation procedure performed, and a new dental implant placed. Freehand surgical placement was selected for the case, as a flap would need to be reflected to visualize the implant site, and the planned implant position was a safe distance from any vital patient anatomy. First, the implant crown was removed, revealing substantial inflammation in the peri-implant soft tissue. The implant was then removed. The socket left by the removed implant and the surround- ing ridge were curetted and aug- mented with a xenograft material. After four months of healing, a sur- gical flap was reflected and an oste- otomy created. A 3.5-mm-diameter Hahn™ Tapered Implant (Glidewell Direct; Irvine, Calif.) was threaded into the implant site with relative ease, and a healing abutment was placed. Four months later, a BruxZir® Solid Zirconia crown was designed based on the final VPS impression. The crown was delivered without compli- cation, establishing a natural-looking emergence profile. Final radiography exhibited stable levels of crestal bone surrounding the implant (Figs. 1a, b). The final result provided the patient withanexcellentlong-termprognosis (Fig. 2). Case example No. 2: Guided surgery A 55-year-old male presented for treatment with a missing second molar. After thorough intraoral and extraoral evaluation, guided implant surgerywasproposedtoandaccepted by the patient, who wanted treatment to be as efficient and painless as possible. Because bone grafting was unnecessary and there was adequate keratinized tissue present, a flap would not need to be reflected, mak- ing the flapless approach facilitated by guided surgery ideal. Further, the addedexpensewasnotanobstaclefor the patient. A digital impression was taken usinganintraoralscanner,whichwas combined with CBCT scanning data to produce the digital treatment plan. A surgical guide was fabricated that would precisely control the location of osteotomy. At the next appointment, a tissue punch was used to access the implant site. The osteotomy was created throughthesurgicalguide.A5.0-mm- diameter Hahn Tapered Implant was placed. With favorable primary stability established, a healing abutment was attached to the implant. After three months, the patient returned for final impressions. Based on the final impression, the lab produced a screw-retained BruxZir crown. The final restoration was delivered without complication (Figs. 3a, b). Final radiography displayed excel- lent crestal bone levels in the area of the Hahn Tapered Implant. exhibitors 8 Yankee Dental Congress — January 29, 2016 Freehand vs. guided surgery: Clinical considerations and case examples 5 Figs. 1a, b: Side-by-side comparison of preoperative radiograph of compromised implant (top) and final radiograph with new Hahn Tapered Implant (bottom) illustrates complete osseointegration as well as regeneration of the crestal bone. (Photos/Provided by Glidewell Laboratories) 5 Fig. 2: The patient was extremely pleased with the final restoration, the CAD/CAM design of which established ideal gingival margins. 5 Figs. 3a, b: The patient’s edentulous space in the area of tooth #30 (left) was restored with precision via guided surgery, which established the exact implant position needed for an esthetic final restoration (right). Here at Yankee TolearnmoreaboutHahnTaperedImplantsandBruxZirSolidZirconiacrowns,stopby the Glidewell Laboratories booth, No. 1600.