Good Teeth Gone Bad: CEREC Guide #29, RCT #30

New patient, has pain #29 and #30.  Short fill with some condensing osteitis.  #29 no fill ;} and mobile.  Patient wanted to keep as many teeth as possible so we opted for a retreat on #30 and immediate implant #29:

Extracted #29 and manufactured the radiographic guide.  When the Thermoplast is in a translucent state, try to line up the central “hole” between the adjacent teeth central fissures:

Plan the implant without CEREC data, then add the “layers” toggling off the CEREC proposal and checking where you are in between the adjacent teeth contacts:

Its so great knowing exactly where the foramen is.  Check that you have adequate thickness in your drill body:

While the drill body was milling I started the retreat on #30.  I always want to know why a fill is short.  Was it due to a separated file?  In the axial we can see “dead space” below the fill, so no it was just short:

Finished the re treat and buildup.  The Guide snaps down nicely:

I have been playing around with the In2guide stopped drills you can buy them separately.  This may be a cool option as they are Zimmer compatible.  I just used the 2.0 pilot then switched back to my tried and true ID drills:

The way I get around not having a stop on my drills is that I set the “D2” to the length of the drill minus the thickness of the keys which in this case was 22mm:

Not to flog a dead horse but this is an image showing the D2 for traditional keys, for the cerec keys you would just subtract 1.0mm not 1.5mm:

Implant placed and indexed manually.  Very nice torque values:

Modified the fixture mount to turn it into a stock abutment:

Implant placed and temp out of occlusion.  The apices of the molar were a little open, hence the mega sealer puff.  This whole appointment took about 1.5 hours.

Final, I like the contours on the implant