Full Arch Implants – Welded Conometric Case

Bill Schaeffer

BDS MBBS FDS RCS MRCS

The Implant Centre

2,460 views

Introduction to the case

Nothing new in the technique here – this is just one of my standard welded conometric cases. It just turned out nicely so I thought I’d post it. The plan is to remove the lower molar and all the upper teeth and to place some implants lower left and upper jaw.

The only tough decision I had was whether to do this case as a hybrid (pink and white) or as a socket-fit bridge (just white).

The patient has lost quite a lot of vertical height of bone – but not evenly – so I decided to go with the nice and simple hybrid. I have just added his PAs from Monday’s review and integration check. These are from two months after implant placement and loading.

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Lateral Incisor Implant Placement and Provisional

Introduction to the case

Pt. presented to my office w/ multiple congenitally missing teeth and existing upper/lower acrylic partials. She finally made up her mind to move into implants to improve her quality of life. For #7, a Nobel Replace select 3.5 X 11.5 was placed and immediately temped w/ a screw retained provisional made over a plastic engaging cylinder w/ access hole through the cingulum. Tooth was taken out of occlusion and all excursions. Pontic was easily cut off her existing partial. I placed the top of the implant 3mm apical to where I wanted the margin of the facial tissue to settle, which buried the implant .5-1mm subcrestal. A final radiograph was taken w/ the screw retained temp in place and I noticed that the cylinder was not completely seated, probably because of the subcrestal placement. Being this is a provisional restoration, I didn’t think much of it, but was curious to see everyone’s thoughts.

When I made the provisional, I screwed down the engaging cylinder, but did not take a confirmation radiograph (mistake?). I then loosened the screw so I could pull the cylinder out with the luxatemp synch impression (mistake?). Either one of these reasons could be why the cylinder was not seating all the way on the final X-ray. Would like to hear everyone’s thoughts and comments about how they make this type of screw down provisional and if they would be concerned that it is not seated all the way. Thanks

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Guided Surgery Should Not Cost You More Than $20 per Case!

Introduction to the case

In the time I’ve been around guided surgery, I’ve gotten to hear all the excuses why people don’t get on board. Some of them are very valid and I even used them myself at one time. One objection is it’s not accurate. It is accurate – far more accurate than what can be accomplished free hand.

But the much more valid arguments were that it was too cost prohibitive (which it was), that it was a lot of work (which it was), and that there were just too many moving parts making the process complex (which there were). Well, I’m pretty excited to share this because these concerns are now going to just evaporate.

The cost and complexity were due to the fact that you needed a CBCT, an optical scanner, an expensive printer, and expensive software to do it yourself, or you had to farm out different parts of the process like scanning or printing to 3rd parties. Now, you’ll be able to do the whole thing in house. The only barrier to entry is the CBCT which is necessary, but you can certainly refer it out to someone – you don’t have to own it.

But now, it’s gotten even better. Now, we can simply scan just an impression without even needing to pour it up. Blue Sky Plan allows us to turn that cone beam scan of the impression into an STL file which can then be “digitally poured” to create the actual STL. This digital pour is done in another free program currently but we’ll eventually have the entire functionality within Blue Sky Plan simplifying it even further. This is a workflow originally figured out by Dr. Rick Ferguson.

This is a notable improvement over scanning the stone models because you almost always have a little bubble in the stone that translates into an error in the guide built on it which will have to be adjusted out for proper fit in the mouth.

With an impression, you might possibly have a bubble, but that’s a positive error that would not affect the fit of the guide – when you “digitally pour” it, it would equate to a bleb on the model.

Also, I actually prefer getting the STL from a scan of PVS putty impression rather than getting the STL from an optical scanner or a CBCT scan of a stone model because the latter two can sometimes be TOO accurate. They pick up every little nook and cranny and then the guide gets built on that and it goes into every nook and cranny too. Then you have to adjust the guide a bit to prevent binding. By using PVS putty, the impression is slightly less detailed, it’s almost like what you would get if you lightly waxed out the embrasures.

So now, you get your STL and your cone beam data from just your CBCT machine. The second major development is that we’ve been testing the Cel Robox printer and the results have been great. This printer is $1500 and if all you’re doing is a guide or 2 a day, it’s sufficient for our purposes and uses food safe materials.

So now, it’s totally realistic to scan the patient and their impression in the morning, plan the case, and have the guide printed by lunch time.

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Part 2: Single Stage Implant – Custom Impression Post and Final Crown

Bill Schaeffer

BDS MBBS FDS RCS MRCS

The Implant Centre

1,756 views

Introduction to the case

This is Part 2 of yesterday’s case, which showed the extraction, placement, and temporary. View Part 1 of today’s case.

This patient has almost perfect teeth, but then developed external resorption of their upper right central incisor. They saw an endodontist who told the patient that it wasn’t restorable, and then the patient found their way to me. The patient has kindly allowed me to show their case.

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Single Stage Implant – Extraction, Placement, Grafting, and Loading of the Implant

Bill Schaeffer

BDS MBBS FDS RCS MRCS

The Implant Centre

2,037 views

Introduction to the case

This patient has almost perfect teeth, but then developed external resorption of their upper right central incisor. They saw an endodontist who told the patient that it wasn’t restorable, and then the patient found their way to me. The patient has kindly allowed me to show their case.

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Socket Shield (SS) Technique for Bone Preservation in Anterior Implants

872 views

Introduction to the case

Replacing a single anterior tooth with an implant is a challenge for every dentist. The risk of losing vestibular bone height and soft tissue is unacceptable from an aesthetic point of view. The presence of osteoclasts on the inner surface of the socket walls indicates that the bundle bone will undergo resorption.

Anatomically, the buccal bone of the teeth is thinner than lingual or palatal bone. Therefore, as bundle bone is a tooth-dependent tissue, it will gradually reduce after extraction. Since there is more bundle bone in the crest of the buccal wall than the lingual wall, hard tissue loss will become most pronounced in the buccal wall (Lindhe, Clinical Periodontology and Implant Dentistry, 2008).

These scientific evidences and the clinical experience of immediate implant placement in fresh extraction sockets have led us to think that by preserving the periodontal tissues on the buccal part of the socket, we could prevent bone resorption in this critical area.

The socket-shield (SS) technique provides a promising treatment, better manages the risks, and preserves the post-extraction tissues in aesthetically challenging cases. We need to preserve and use the bundle bone to our advantage.

The principle is to prepare the root of a tooth indicated for extraction in such a manner that the buccal root section remains in-situ with its physiologic relation to the buccal plate intact. The tooth root section’s periodontal attachment (periodontal ligament (PDL), attachment fibers, vascularization, root cementum, bundle bone, alveolar bone) is intended to remain vital and undamaged so as to prevent the expected post-extraction socket remodeling and to support the buccal / facial tissues. (Howard Gluckman, Jonathan Du Toit, Maurice Salama).

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