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CLINICAL CASE REPORT a NobelReplace ® Select RP (Regular Platform) tapered implant (Nobel Biocare; Yorba Linda, Calif.) was chosen, and at the site of tooth #5, a NobelReplace Select NP (Narrow Platform) tapered implant (Nobel Biocare) was selected. An appointment was set to try in the surgical guide and confirm the fit before starting the surgical procedure. Planned cutouts placed at the marginal ridge areas adjacent to the missing teeth allowed for a visual window to confirm the full seating of the tooth-supported surgical guide (Fig. 9). Using CAD software, laboratory technicians designed screw-retained Inclusive ® Custom Temporary Abutments (<strong>Glidewell</strong> Laboratories) from the virtual position of the implant fixtures (Fig. 10). Custom provisional crowns were designed with the CAD software to fit the custom temporary abutments’ marginal design (Fig. 11). The crowns were designed to optimize the buccal and lingual contours and marginal adaptation, with the occlusal anatomy intentionally left out of occlusion to minimize occlusal forces on the implant fixtures (Fig. 12). The screw-retained Inclusive Custom Temporary Abutments were milled out of a specially compounded, radiopaque polyether ether ketone (PEEK). The BioTemps ® crowns were manufactured using the lab’s CAD/CAM process. Fit was confirmed between the milled temporary abutments and the milled crowns. Implant analogs were used to confirm the fit of the provisional restorations to the implant fixtures (Fig. 13). Phase II: Surgical Local anesthesia consisted of two carpules of 2% lidocaine with 1/100,000 epinephrine (Fig. 14). The tooth-supported surgical guide was soaked in antiseptic solution, and full seating was confirmed using the proximal observation windows (Fig. 15). The guided surgery drills were used with the surgical handpiece. A tissue punch (Nobel Biocare; Yorba Linda, Calif.) was used to remove a cylinder of tissue for bone level access (Figs. 16, 17). The first osteotomy site was for tooth #4. The first entry was made with the RP countersink drill (Nobel Biocare) (Fig. 18). Guided by the 2 mm guide collimator, the 2 mm twist drill (Nobel Biocare) was then used (Fig. 19). The precise depth was marked using a drill stop and markings on the twist drill (Fig. 20). The next two sequence drills were used, including the NobelReplace guided drill series for the RP implant size (Fig. 21). The second osteotomy site — for tooth #5 — was prepared with the countersink drill, and then with the 2 mm twist drill, followed by the last sequenced NP drill (Fig. 22). With the surgical guide in place, and using the implant fixture holder (Nobel Biocare), each of the implants were Figure 9: Surgical guide try-in. Figure 9: Surgical guide try-in. Figure 10: CAD design of custom temporary abutments. Figure 11: CAD design of custom provisional crowns. Figure 12: CAD design and verification of implant crown orientation. 58 – www.inclusivemagazine.com –
Figure 13: Inclusive Custom Temporary Abutment on implant analog with custom BioTemps crown. Figure 17: Tissue punch being used with the surgical guide. Figure 14: Administration of local anesthesia. Figure 18: First drill used in drilling sequence, initial RP countersink drill. Figure 15: Tooth-supported surgical guide seated in patient’s mouth. Figure 19: 2 mm twist drill, second drill used in drilling sequence. Figure 16: Tissue punch used in this case. Figure 20: 2 mm twist drill with stop inserted into the guide. – iTero Digital Scanning Technology and Tooth-Supported Surgical Guides – 59
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Inclusive Restorative Driven Implan
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Contents 9 20 29 36 Implant Q&A: An
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Letter from the Editor This issue o
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■ JACK A. HAHN, DDS Dr. Jack Hahn
Page 9 and 10: Online Exclusive R&D CORNER “Digi
Page 11 and 12: Implant& Q A: Go online for in-dept
Page 13 and 14: DC: We often hear that endodontics
Page 15 and 16: markets have been highly penetrated
Page 17 and 18: get fibrous encapsulation. By going
Page 19 and 20: type they were. And what was wrong?
Page 21 and 22: The young dental professionals of t
Page 23 and 24: Go online for in-depth content Mini
Page 25: Courtesy of Christopher P. Travis,
Page 28: When I reached out to Dr. James, he
Page 32 and 33: the clinical advantages of custom A
Page 34 and 35: the clinical advantages of custom A
Page 38 and 39: educing treatment time with digital
Page 48 and 49: System-specific intraoral workflow
Page 51 and 52: Go online for in-depth content BRID
Page 53 and 54: 1 2 6 7 Figures 1, 2: Preoperative
Page 55 and 56: Figure 21: A polyvinyl siloxane imp
Page 57 and 58: Clinical Case Report Go online for
Page 59: would be designed and milled from t
Page 63 and 64: A panoramic radiograph was taken wi
Page 65 and 66: Discussion Several types of technol
Page 69 and 70: Optical Impressions and Full-Arch I
Page 71 and 72: The final restoration was fabricate
Page 73 and 74: Figure 9: The VDO was measured prev
Page 75 and 76: LAB SENSE Go online for in-depth co
Page 77 and 78: Figure 1: The Screw-Retained Hybrid
Page 81 and 82: CLINICAL TIP Managing Implants in P
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