Ok here’s another one. This is a Classic Guide case. Why, you may ask, use a Classic Guide? Well, I’ll tell you. We use a Classic Guide if we have a lot of metal noise, if we use a radiographic guide, or if we need a palate. So in this case we needed it for noise. Patient has an existing bridge with decay around #28 that that was mobile due to the decay loosening it up. We elected to cut out the pontics and leave the crowns for stability then removed them and did the endo on #28. Scanned the stone model for the SSI, don’t really need to do it in the mouth.
You can see in the right Galileos image how much noise and just yuck we get. So we use “Clip Along Active Slice” and use the CEREC model we scanned to allow us to place the implants right where we want them.
Fresh off the plane from Germany, note that SICAT cuts away the teeth for you. Also this functions as a vent for irrigation. We used the Large Guide Sleeves from Implant Direct which require the metal spacers to adapt the 2.3/2.8 and the 3.4/3.8 handles.
You can see we are lacking in the attached tissue department. By “pumping up” the tissue with 1:100K lido with epi we can see that the attached tissue comes up on the ridge, so I wanted to displace tissue from the lingual.
We know we are dealing with D2 bone here, so we used the very cool Crestal Bone Drill, from Implant Direct that just opens up the coronal 5mm of cortical bone to the same size as our implant while allowing the trabecular bone to expand with the implant insertion.
Placed our implants. I’m playing around with HA on everything to see if there is increase in torque at un covery. Dr Niznick swears by it, and obviously he knows a bit more about Implanvology than I. I used a contour healer on #30 and a cylindrical on #29 due to space issues. I know, I know I’ll never make it as a seamstress, but I did my best to apically position the flap.