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Creating Surgical Guides Using CBCT and Intraoral Scanning
Figure 9: Full-depth surgical drill placed in metal guide holes of the surgical
guide
Figure 10: Implant delivery tool on the handpiece
Drills) to match the implant fixture shape (Fig. 9). These
drills were used to precisely create the osteotomy in all
dimensions of space, including depth. Both implant sites
were drilled to the precise depth and shape for planned
implant placement.
An 8 mm long NobelReplace ® Tapered RP implant (Nobel
Biocare) was placed at the site of tooth #29, and a 10 mm
long NobelReplace Tapered RP implant was placed at the
site of tooth #30. Using the guided implant mount, the two
respective implant fixtures were carried with the implant
driver (Fig. 10) and rotated to a position just short of full
depth (Fig. 11). Using a manual torque wrench, the implants
were rotated into place such that the shoulder of the implant
holder mated with the surgical guide at a torque value of
35 Ncm (Figs. 12, 13). The guided mount and surgical guide
were removed and 5 mm RP Healing Abutments (Nobel
Biocare) were rotated into the NobelReplace Tapered RP
implant (Figs. 14, 15). There were no complications, and
in fact, the patient reported this was the easiest dental
procedure performed on him to date.
Figure 11: Placement of implant with the delivery tool with full depth held
back approximately 1 mm
Implant Restoration
After four months of healing, the patient returned for
restoration of the two implants. The healing abutments were
removed (Fig. 16) and an Osstell ® ISQ implant stability meter
with SmartPeg attachments (Osstell Inc. USA; Linthicum,
Md.) was used to check the level of relative implant osseous
integration (Fig. 17). A SmartPeg attachment was placed in
each implant fixture and a reading of 85 was recorded for
each implant. Further, a “reverse” torque test was performed
using a manual torque wrench, with no movement
at 35 Ncm. The implants were deemed satisfactory for
restoration and functional occlusal loading.
Figure 12: Manual torque wrench used for final seating of the implants to
35 Ncm
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