This case was fun because it highlights the struggle: Screw access in the Anterior. Patient broke #8, crown and post are loose, fracture at the bone level. As you can see in the CBCT a proposed implant would have a screw retained crown with a facial access. Not sexy.
I really wanted to do this guided. Anterior immediate implants are hard. Very little buccal bone and a socket that acts as a ski ramp, forcing your drill out the buccal plate. But I couldn’t remove the loose post and have this patient walk around like a Carnival Worker while I made my guide, so the tooth was digitally removed in Blue Sky Plan, made a guide with the super fast Guide Wizard and off I went using the Bio Horizons Guided kit to place a Legacy Implant.
4.2 Mountless Legacy placed fully guided. Lil Nasal bump there. Pretty easy surgery.
Designed and milled my initial temp in CEREC with Enamic as my CAD Designer, Jacob Farber was sleeping in MInsk while I was seeing this patient. Note the F-ugly screw access as we are limited by the “hole” in the Enamic IS block and a straight Ti Base.
The next day I got the 3Shape design of the crown with he lingual access using an off axis screw channel on a Smart Base by Implant Direct with a 1mm pink gingival collar and printed it with N1 and N2 Nextdent MFH resin on the Asiga Max UV printer.
I think we got a pretty decent result. About $60 for the ti base and $5 in resin for the temp. Had to shorten it to avoid the lowers. You need to use a special ball ended screwdriver to torque down to 20 Ncm for the temp.
We are doing a CEREC Live Patient Implant Course in Phoenix where we will cover CEREC Guide 2, Scanning with Scan Posts for Abutments and Crowns, as well as demoing full arch scanning with Primescan and Digital Dentures! Feb 20-22 2020. If you are a Trios user we can adapt the hands on for you!
If you want to know how to make guides, aligners, digital dentures and more, come to a 3D Printing party!! Jan 17-18 in Minneapolis!!
We are also doing one in Richmond VA April 17-18!