Who Let the Dogs Out? Canine Immediate with CEREC Guide and Interactive Implant Fully Guided.

 

 

I love having CEREC Guide 2 in my office and as a GP the vast majority of what I do is single unit cases.  Although I never immediately temporize Canines due to the lateral occlusion on it., I love doing immediate placement.  Here we planned for an Interactive mount free implant from Implant Direct in CEREC and Galielos.  As always, crown down.

 

One common question I get asked is if you need to extract the tooth first. If the root is broken at the gumline then no, but if the clinical crown is intact you can pour up a model and drill the tooth out or just extract it first and then image for your guide in both CEREC and Galileos.

 

Rather than buy that giant nobel kit for CEREC guide 2, I used the 2.3 and 2.8 ID drills with my CEREC Guide 2 keys with the extra long drills. For the Nobel Guided kit you need to add 10 to the length of implant you are using then subtract mm for the D2. In this case we are using a 3.7 by 16 to our d2 is 25 the long ID drills have a mark at 26.

Love the feel of fully guided insertion as you know that in an immediate situation we are only engaging the implant from the bottom 3mm or so past the socket and the implant can really swing buccal or lingual.  The CEREC guide locks it in and the mount for the NP and RP fits the S and M sleeves well.

You can see a really large gap on the buccal and lingual. Filled with DFDBA and a reservable collagen membrane. Note the X-ray and the proximity to #12! Looks like I am right on it and then look at the implant in the socket we have about 2mm between the implant and the root.  This is a common problem due to the flat sensors we use and the curve of the maxillary arch.  Will restore later with a custom emax abutment and crown.