Here is a patient that came out of state for some implants that required some “on the fly” thinking. Missing #12-14 with #s 15 and 16 drifting a bit mesial. This patient had a scan from before so I did not have the luxury of a radiographic guide and he had models so I ordered a wax-up, scanned it in the Omnicam and planned the case. We were really tight for space and I debated on an implant bridge vs individual units.
Its really easy to get a wax up into Galileos from CEREC. Just pick any restoration type (veneer, inlay, crown it does not matter). In the Model Screen, mark a margin anywhere on the model (even on the palate, again it does not matter) just keep hitting the forward arrow until you get to the mill preview. Export the squishy proposal as a .ssi into Galileos using a USB drive or if you are hooked into a network, move your file to the Galielos PC.
As you can see we are lacking attached tissue throughout the edentulous space. SICAT gave me the option of two guide sleeves or one guide sleeve and two pilots. I really wanted to get three implants in there, so I still held onto the pilots and wanted to give it a go. #16 and #15 will be crowned at the same time we restore the implants.
Crestal incision placed palatally to move the attached tissue to the buccal. Wider at the base for more blood supply.
After placing my first two angulation pins it was evident that I just did not have room for a third implant. You can really see how #15 is tipped medial. Just be able to “upright” it with the crown and provide a bit more room for the crown on #14
Even though I had great insertion torque I opted for a one stage procedure. The patient had a flipper but was told not to wear it for the 4 months of healing.
Anatomic healing abutments placed and the flap positioned apically. We should get more attached tissue forming in the exposed areas. Usually would have gone with non resorbable sutures but in this case, this patient came to see me from out of state and could not regularly fly back to have them removed. Got a few more in and closed the mesial a bit more. Excited to see if we get more attached tissue on the buccal.