This CERECGuide Case Holds Me Down and Taunts Me: Compared pilot drill path in CERECGuide

Last week was had a ton of immediates, here is the first of two I actually got to take images on:

#9 fractured at the gum line, I love the “post-but-no endo” technique, patient super glued the tooth back, it was useless so we had to free hand the temp:

I usually like to extract first then make my Radiographic Guide, but I was working in this patient between a few others, so I did not have down the time, my assistant made the Radiographic Guide as I finished up on another:

One common problem, at least that I have had in the past, was that in immediates you have to aim palatal to get a purchase then upright your drill to get the implant back into position.  This is easier said than done.  A lot of times the platform goes buccal.  Even if this does not engage the buccal plate, which is bad enough, as the platform rotates buccal it also drops apically.  This results in a crown that’s longer than the rest of the teeth:

By keeping the platform palatal, you have a ton of control of the emergence file to the buccal. This graphic is a bit extreme, but even in this case the worst that you would end up with is a bit of a ridge lap, vs a longer crown.

As the CEREC Guide was being milled I extracted the root:

Had an excess of the Thermoplastic Material, so I removed some, sort of like a window on a surgical guide you can verify the seating:

So this is where things get awesome.  I like to place my pilot in the initial osteotomy to make sure that we are on the right track.  I went back and did not change anything on my virtual implant placement.  Look at the comparison, thats incredible accuracy, chair side!

Look at the palatal inclination of the implant with the screw hole exiting out the cingulum.  Thats just bananas!:

Went through the series, I placed the 3.5 drill in the guide but do not hit the gas until the topmost portion engages the guide sleeve:

Placed the implant without the Guide in place, good mesial distal alignment:

I placed a stock Zirconia Abutment from Implant Direct, note the placement relative to the plan

Here is another view showing the palatal placement and the resulting angulation of the abutment, very little prepping involved.

I finally paid the big bucks and got ID’s new prep kit.  Cuts like butter and I hate prepping zirconia.

Final placement as planned, I shortened that temp a bit.  I just love doing these cases guided and having the ability to do these chair side.

 

 

Final, tough matching old pfms but I think we got a decent result.