Bump it: Internal Lift with CEREC Guide

Here is a case that I have posted previously that came back for her crown.  The old images were not up to my current posting standards so I reposed some “dolled up” surgical images ;} PLanned the implant short of the sinus, had about 6mm wanted 4 more:

Nice wide ridge and tons of attached tissue:

Many times the punches are too short for the guides so get a drill entender.  In this case its the ID one:

2.0mm pilot, pin placed:

Love the MIS Internal lift kit.  One day i will grow a sack and learn lateral lifts:

Drilled up to the sinus floor and then infractured the floor with expanders both guided and non guided with a ratchet:

I used the last drill non guided to about 6mm but will let the Implant lift the floor and membrane:

Decent placement, good additional length:

Sinus intact on 3D scan:

patient back in 4 months for impression.  Always freak out a little when using a screwdriver in the mouth.  Seems more stressful to me than the surgery!

Im just loving these fixture level, closed tray snappies by Nobel.  Not so much for the impression, just because they are an exaggeration of the implant position.  Look at my indexing, I thought I was perfect, but it looks like I am a little off.  I think I will keep these patient specific, but use them at surgery to confirm my angulation and indexing, then keep them with the patient’s name for impressions:

In the software I use the drill extentions to exaggerate the implant position.  Here is a slide I made in 3DS max illustrating this:

Here we see the same thing with the impression coping, looks like we are lined up:

I get asked all the time in my classes “Which is better a tri lobe or a hex for beginners?”  When it  comes to indexing and placing an abutment, a trilobe is easier.  But keep in mind that if the lobe in not in the right position, the implant will travel longer apically to get there than if you are moving from one hex position to another:

used my sharpie to indicate the buccal.  We can see the effect of platform position in the “bulbousness” of the crown.  In this case, we could not flatten the ridge to get the platform more apical, as I was already fighting for bone and needed to do a lift.

Abutment Placed and Indexed:

Final Crown, patient wanted to go lighter: