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ePaper created 2017-11-09, 09:28:26 | version 1.38.0
| industry Implant insertion through the DWOS Synergy™ workflow Dr Richard Zimmermann & Dr Stefanie Seitz, USA Initial situation A 30-year-old female with non-contributory medical history presented to the clinic for evaluation of a max- illary edentulous site. Review of her dental history re- vealed that tooth 12 (ADA) was lost due to failed end- odontic therapy approximately a year ago during her pregnancy and she was now ready to have it replaced. She presented with a high smile line, medium-scalloped gingiva with medium thickness and a desire not to have any metal in her oral cavity. When discussing the various options regarding implant therapy, the patient was very interested in being evaluated for an all ceramic implant. On January 11, the FDA cleared the Straumann® PURE Ceramic Implant for use within the US. Though new to the US, European case documentation has shown excellent osseointegration and soft tissue response. The Straumann® PURE Ceramic Implant is a monotype style implant, meaning the abutment and implant body are one-piece. Treatment planning The patient was sent to get a computerised cone beam tomography (J. Morita, USA) of the area and digi- tal diagnostic impressions were taken using an intraoral scanner (TRIOS 3, 3Shape). Once obtained, the DICOMs were imported into the implant planning software (coDiagnostiX™) while the scan files were imported into the laboratory software (Straumann® CARES® Visual; Figs. 1 & 2). Since the Straumann® PURE Ceramic Implant are monobody in design and it is not recom- mended to modify the abutment, the DWOS Synergy™ workflow was utilised to virtually plan this case. DWOS Synergy™ provides real-time communication between the implant planning software (coDiagnostiX™) and the lab software (Straumann® CARES® Visual). This feature improves implant planning by allowing the visualisation of the relationship between the proposed implant posi- tion and the proposed restoration. Modifications made to the implant position or resto- ration design are immediately transferred to the other software, providing instantaneous feedback on how the modification of one affects the other. Of special interest in regard to the Straumann® PURE Ceramic Im- plant is that one can design the restoration and ensure that the planned position will not require modification for restorative materials. Once the planning was com- plete, both the surgical guide and the provisional de- signs were sent off for fabrication. The guide was sent to a lab to be printed by an Objet30 OrthoDesk (Stratasys) while the provisional file was sent to Straumann Milling Center in Arlington to be fabricated out of polycon ae (PMMA; Figs. 3 & 4). During the surgical planning utilis- ing the DWOS Synergy™ workflow, a Straumann® PURE Ceramic Implant (Ø 4.1 x 12 mm) was selected with an abutment height of 5.5 mm. Surgical procedure The Straumann® PURE Ceramic Implant design is a combination of the tissue level and bone level implant— the neck of the implant mirrors the Straumann® Tissue Level implant while the implant body mimics the Straumann® Bone Level design (Fig. 5). As such, the surgical proto- col for preparing the osteotomy for the PURE is the same as the corresponding Bone Level implant. For this case a guide was used to prepare the osteotomy following the protocol set forth for Bone Level implants given by coDiagnostiX™. Though this case was performed with Straumann Guided Surgery (SGS), a small flap was made to ensure the desired position of the Straumann® PURE Ceramic Implant shoulder. SGS utilises different combi- nations of sleeve positions, drill lengths and drill handles to prepare the osteotomy to the correct depth. Sleeves can be placed at three different heights from the implant level (2, 4 or 6 mm) based on the case and surgeon’s preference. The combination of drill length (short, long or extra-long) and drill handle (1 or 3 mm) are determined by the implant planning software which provides the surgical protocol to use at time of surgery. The Straumann® PURE Ceramic Implant system uses a series of “position indicators” that aid in ensuring the correct position of the implant during surgery. Both abut- ment diameters and heights have corresponding posi- tion indicators that are placed into the osteotomy for evaluation (Fig. 6). Once the osteotomy has been pre- pared, typically a surgeon will use a “guided implant”, 22 implants 1 2017