Categories ; Posterior, CBCT, multiple implants, Nobel Biocare,
Copyright Š 2011 Idondivi, Inc. All rights reserved.
There is bone , but is it in the right place for our prosthetic needs ?
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cbct
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VPS Is radio opaque, a small impression (or a full arch impression) worn during CBCT scanning allows visualization of the soft tissues in relation to the bone. Transfer to the cast is simple
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A small VPS bite registration material impression can be made if the patient has to go to an external radiology center. If the CBCT is in the office, then a scan can be made while the full mouth VPS impression is still in the patients mouth, even if the impression is still setting, so no time is lost. Note ; these images are from another patient. Copyright Š 2011 Idondivi, Inc. All rights reserved
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# 21 site
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# 20 site
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A pinhole is drilled to place the top of the implant, in this case subcrestal to allow sufficient room for the emergence profile
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BLP’s in place. The BLP will lock in the bucco- lingual position and the top of the implant. It still allows precision adjustments to the mesio-distal placement
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Wings cut from the buccal and lingual wings for site by site implants
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Note the buccal space for flap reflection
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0 degree ( green ) rotation blocks ( RP) in place
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Correctly exposed radiograph, indicates reliable diagnostic interpretation; no need for correction , so use 0 degree ( green ) rotation-blocks
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Guided surgery does NOT mean flapless surgery, mini-flap allows transportation of attached tissue towards the buccal
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Final osteotomies
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Implant placement. Note that because the ridge was not flattened as is common in non guided surgery the implant # 20 appears to be placed deep. This is however exactly as planned to get adequate buccal bone coverage. The guided bone-mill is used to create space to place the healing caps. The body will resorb as needed. Copyright Š 2011 Idondivi, Inc. All rights reserved
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Sub crestal placement exactly as planned per prosthetic outcome and bone availability
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Initial ISQ , allows monitoring of osseointegration
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Attached tissue is positioned buccal of the healing caps.
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Guided and delivered as planned
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