Return of the Mack: 7mm Immediate Implant with CEREC Guide

One of the toughest immediates out there are immediate molars. In essence we are trying to shoot a bullseye, aiming for a small patch of bone between multiple root sockets. Guided Surgery really helps, but even then there is a tendency for the drill to “walk”. Here is a little sequencing technique using the new CEREC Guide that helps keep your osteotomy as straight as an arrow:

This patient presented with #14 broken off at the gumline, we discussed options and CL would expose the furcations so we talked about extracting and grafting. She already had a hard time with a 4 month standard one stage surgery, if we grafted that would add another 3 months, so we decided to give an immediate a try. In molars I always let my patients know that there may be a chance that we dont have enough bone and thus we would need to extract and graft:

In immediates I usually extract first and then take a scan. But I want to drill my pilot THROUGH THE TOOTH, using the dentin to stabilize my drill so it would not walk. I took a wheel diamond and flattened the tooth out:

Fabricated my radiographic Guide with a Reference Body:

Scanned the patient. Positioned my implant into the Sinus Septa between the divergent roots:

Planned my implant to draw with the adjacent teeth contacts, placed in the central pit of the CEREC proposal, identified my Reference Body:

In from the CEREC as a .ssi file, out to the CEREC as a .dxd, cmg file:

Assemple all the parts and pices, always confirm that the drill body seats:

Seated in the mouth, I like to extend to the Incisor so I can really verify seating:

Using the Nobel Sirona 2.0mm key and the Nobel Guided Pilot at 22mm (3rd mark from the apex) drill a hole through the tooth. Thats right, through the furcation:

This is a RP 2mm Nobel angulation pin. Just want to make sure I am in the furcation, not into a root:

Section and renove the roots with Luxators. Now why would you not just finish the osteotomy first? First, its hard drilling dentin with Implant Drills. Second, you end up with these little slivers of root and gutta percha all over your osteotomy. After removing the root you still have a nice pilot and the rest will still be guided:

This to me is the holy grail of Guided Surgery. That pilot hole is right in the middle of the furcation. Incredible accuracy, chairside!

Now I am using the IMPLANT DIRECT NON GUIDED KIT, the D2 is set at 22mm which is the length of my standard, garden variety implant direct drills to the head of my hand piece which is the hard stop. This is not a Guided Kit.