Happy Hour: 1 Hour CEREC Guide Case with Immediate Molar Implant

 

This is another simple case. I feel reluctant to post these as they are pretty old hat by now, but I know some docs have never done a CEREC Guide or an immediate molar, so if it helps one person it is worth it. I did this endo about 7 years ago and it started to get heat sensitive and throbs on its own without stimulus. I did an implant on this patient’s wife and gave him the option of seeing an endodontist for a retreat, but he just wanted it done and done by me. Could I have retreated it? Sure but CBCT revealed no MB2 and a very cylindrical root. So in these cases I really just give the option of referral to endo or extract. Patterson no longer carries the Mach 2 with powder in it, they carry the “tan” one which is no biggie as I have an omnicam. Cut the tooth down as we are sectioning anyway to make room for a large reference body.

Got my proposal from CEREC and exported it into Galileos. Lots of bone in the furcation for a 7mm by 11.5 Legacy 4 Implant Direct Implant.

 
Off the Mach 2 model, use your thermoplastic material. In the heated state it is translucent. Notice how I goofed! The “T” really should be palatal. Just make sure you get your drill body in there right. Scanned with “radiographic guide”

 

And again, I was doing it all wrong before. Get your Drill Body from CEREC, replace the Reference body with it THEN cut your hole in the thermoplastic material.
 

 

Cut a hole in the furcation with a surgical 557 in a surgical hand piece. Use the 2.3mm drill with my handy dandy keys. Section and remove the roots, leaving a 2.3mm glide path created with the pilot.

 

 
The new keys are blue but you get the picture. The Large keys go up to the 5.1, so in this case you may have to use the 5.4 free hand as well as the 7mm crystal bone drill, which you have to use free hand anyway.

 
Did not have any HA in my drawer so I used SBM. Use the healing abutment to tack down your membrane after grafting. I was a little more palatal than usual so I had a lot to graft on the buccal. All in all a nice smooth case.