Posted June 4, 2014
http://www.Digitalenamel.tvYet another somewhat tricky case. Failed endo on #10, lots of bone loss. Extracted and did a lot of grafting. Obviously this is not a case for immediate implant placement so the patient wore a flipper for 3 months while it healed. Scanned in CEREC to get a crown proposal.
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We use pilot guides for two instances, at least I do. I use them when I know I am going to do a lot of bone re contouring. And I use them if the guide sleeve is too large for the edentulous space. In this case the Implant Direct small sleeve was too large so we went with the 2.3 pilot sleeve. That being said I know in this case I am using a 3.0mm implant and will most likely in the grafted bone just drill to the 2.3 so I set the d2 to 23.5 which would give me a stop at the hub of the hand piece with no handle.
Nice and clean. Drilled into the gingiva. I usually don’t like to do this but I really irrigated out the small osteotomy to make sure that there was no tissue. Only used the 2.3mm drill as planned.
This patient had great tissue. Unfortunately the bone was still soft so we could not temporize at surgery so the flipper went back on.
Patient came back at 4 months for uncovery and impressions. I love this DEKA laser, really gets the tissue out of there. Not good with the whole charring thing, but if you lack patience like me, it really gets the job done in a hurry. The image in the upper left is at surgery and you can see how that tissue really grew over the long healing abutment.
Open tray impression. I find that with these 3.0 I have a hard time indexing the closed tray impression coping in deep tissue. Just personal preference, I went with open.
You all know I am a huge fan of using Emax abutments and Sirona Ti-bases. But there is no Sirona Ti Base for the 3.0 Legacy! So Custom Direct has not released it yet, but they have a great line of custom titanium and zirconia abutments! Stay tuned for the release! You can get titanium now as well as Hybrid Bars and Over Denture Bars.
I tried imaging off the abutment model, but kept getting weird artifacts. Scanned in the mouth. I used a B1 Empress CAD Multi as I wanted some translucency. Hoping the papilla will fill in over time. Great torque at 30 Ncm (always a little worried with these little impacts in grafted bone.) You can see the bone level is bait apical on #10. I think that would have been different if we had not used a flipper, but there was no way with that huge defect.
