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Implant Tribune United Kingdom Edition | 5+6/2017 IMPLANT TRENDS 19 1 3 4 5 2 Fig. 1: An illustrative image of Dr Burgess using Navident. — Fig. 2: A CBCT scan was taken two weeks prior to surgery. — Fig. 3: The treatment plan was created imme- diately after the scan. — Fig. 4: The patient was able to see the proposed treatment displayed by the Navident software. — Fig. 5: The author was able to achieve the best buccal and lingual position of the implants, and their relation to each other and to adjacent teeth. the simple Navident protocol for calibration and verifi cation of the drill axis and drill tip was carried out. A crestal incision was made, with a minimal fl ap refl ected. The software shows the drill position on the scan in real time, as it enters the jaw. This allows adjustments to be made, if necessary, whilst the site is being drilled. Two Dentsply Ankylos® CX 3.5 mm di- ameter dental implants were placed subcrestally in the lower left fi rst and second molar sites, with implant lengths of 11 mm and 9.5 mm respectively. Avoiding damage to the infe- rior alveolar nerve was a crucial factor in the treatment planning of this case. Access was diffi cult, due to the limited opening of the patient’s mouth. The issue was compounded by the plan to place an implant as distal as the sec- ond molar. These challenges were overcome using Navident’s continuous internal visual feed- back, which gave the author the confi dence to use the optimum length of implant, whilst staying within a safe distance from the inferior alveolar nerve and avoiding post- surgical complica- tions, such as paraesthesia. Navident provided guidance for accurate implant location, even with restricted visibility and the drill being impeded by opposing teeth. Tactile feedback can often be reduced when using a physical drill guide. Dynamic navigation removes this obsta- cle. The author was able to achieve the best-possible buccal and lingual position of the im- plants, and their relation to each other and to adjacent teeth (Fig. 5). This would allow for opti- mal shape, position and occlusal function of the fi nal restora- tions. Ankylos® Balance posterior sulcus formers were fi tted and the incision was closed with sim- ple interrupted sutures. There was no need for bone augmenta- tion. Two to three months after surgery, the implants will be re- stored with Atlantis® custom made CAD/CAM titanium abut- ments and screw-retained linked zirconia crowns. Conclusion The clinical outcome was ex- cellent. The planned placement was restoratively driven and the implants were well positioned, with good primary stability. Hav- ing used the Navident dynamic navigation system for more than a year, the author would not want to go back to preparing and plac- ing dental implants without its 3-D visual guidance. The patient was comfortable and reassured, with no postoperative pain, swelling, bruising or paraesthe- sia. He was delighted and, if he needed any implant treatment in the future, would insist on dy- namic navigation. Dr David Burgess BDS DPDS MScConSed has been principal of Carbis Bay Dental Care in Cornwall since 1988 and has placed over 2,000 implants. Throughout his career, David has striven to combine clinical perfection with the ultimate in patient care. He has been a willing pioneer of new technology, particularly in the fi eld of digital dentistry. David was the fi rst UK clinician to introduce the Navident dynamic navigation system into his implant treatment workfl ow, with the objective of achieving a higher degree of preci- sion and greater patient comfort. David Burgess is also a member of the Dynamic Navigation Society as a Master Clinical Trainer, providing courses for implantologists who wish to experience how dynamic navigation can help to simplify their digital workfl ow. More information can be found on http://dns.claronav. com.