Clinical Case: Gordon-E

Prototype : same concept different look Categories : Posterior, grafting, multiple implants, prototype, Nobel Biocare

Failing 3 unit bridge abutment tooth # 29

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Cast is cut at proposed implant axis

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Implant angle based on prosthetic outcome. More buccal on site were premolar is to be extracted, anticipating buccal boneloss.

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Prototype BLP glued into place. Determining bucco-lingual position and the top of the implant

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Prototype BLPâ&#x20AC;&#x2122;s positioned for side by side implants

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Surgical guide in place while tooth # 29 and pontic # 30 have not yet been removed.

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X-ray not shot perpendicular. Double view of RIR’s. Current RIR’s are fully radio- opaque , while prototypes only on the outlines

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X-ray shot correctly, overlap RIR. 7 degree rotation block indicated to engage some native bone on the mesial , so on purpose not following the existing alveolus

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Guided surgery does not mean flapless surgery

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Foramen relative to tooth apex as visualized on PA radiograph

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Very precise depth control is needed as we are close to the foramen , Drill set at 7 mm

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Very precise depth control is needed as we are close to the foramen , Drill set at 10 mm. Still short from the apex. In this way we are always safely away from the foramen.

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Implant placement and bone augmentation

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Green line bottom of the implant

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Green line bottom of the implant

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Actual distance between implant tip and foramen 2.9 mm, while on 2 dimensial PA radiograph it would appear to be 1.4 mm

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Non resorbable membrane protect bone augmentation and will develop abundant keratinized gingiva.

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8 weeks post placement

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Restored with two single crowns

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