Go Big Or Go Home: CEREC Guide, Sinus Lift, Custom Titanium Abutment

Here is a completed case using CEREC Guide, an internal lift, a legacy implant, and a custom titanium abutment from Implant Direct.  Edentulous space was too narrow for a large so we went with a medium reference body.  I would say the majority of what I do with CEREC Guide is either a small or medium block.

Not enough bone above the sinus and we need about 3mm more so we planned for a bump.  Plan your implant just at the sinus floor.

You can see the height of the drill body is out there due to the fact that the planned implant is only about 6mm in bone.

With the MIS Expander Kit you start with these sharp rotary osteotomes and once you get to the sinus floor you move to blunt ones. We had more bone closer to the pre-molar hence the off center apex of the osteotomy.

First expander at the floor, you can switch between rotary and hand ratcheting the osteotome.

5.2 by 10mm Legacy 3.  Large healing abutment.

We gained a few mm.  I did not pack bone ahead of my implant. If I can feel the hard floor of the sinus I usually do.  In this case I could feel the membrane was intact, but did not want to risk getting graft in the sinus.

Found out later about the Contour Healers, so I switched it out.  Look at the tissue profile with the contour healer.

Custom abutment from implant direct, I like to work my way up in torque either putting the implant in or torqing  down screws.  If your hex tool is not firmly in the screw and you torque to 30 you can strip the hex.

I started beta testing Custom Direct after I had ordered the original crown, so I thought it would be cool to compare a custom abutment to a stock.  To be honest in this case not a huge difference.  The crown at the top with the custom abutment exerts less pressure on the buccal gingiva and looks more at home in the arch.  The lower looks longer and more bulky.  But I think both are acceptable.

Just a final from the occlusal showing the size of these healing abutments and final abutments.  Pretty cool!  I like the fact with a custom you can get greater ferrule and position the center margin more coronal.