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SIMPLANT® computer guidedimplant treatment with theASTRA TECH Implant System™EV with Immediate Smile®

featuring ATLANTIS™ Abutment

A 65 year old male presented with a failingconventional cantilever bridge replacing tooth12. The abutment tooth 13 had previously beentreated with apical surgery and had dentalcaries compromising the margins of the post-retained crown. The patient requested animmediate smile solution if possible. Theclinical situation presented itself suitable for anImmediate Smile featuring ATLANTIS Abutmentutilising the SIMPLANT Safe guide andsoftware from Dentsply Sirona. An ASTRATECH OsseoSpeed EV implant in combinationwith ATLANTIS abutment and CAD-CAMtemporary crown was chosen to achieveimmediate replacement and excellentaesthetics.

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Case ReportDr Thomas Sealey

BChD, MMedEd, DipEndoBest Young Dentist South-East 2015

Start-Smiling Dental PracticeIngatestone

EssexCM4 0BY

info@start-smiling.co.uk@StartSmiling1

@ThomasSealey1

1. Pre-operative radiograph

An upper digital periapical radiograph showingcaries under the mesial margin of the crownabutment on a conventional cantilever bridgereplacing missing tooth 12.

2. Initial clinical situation

After bridge removal , showing compromised post-core with caries on tooth 13. Unsuitable to act as anabutment to support a new bridge. This tooth will berestored separately.

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3. Bridge removal and temporisation of tooth 13

The bridge was removed and a temporary acryliccrown made for tooth 13. A CBCT scan was takento assess the area for suitability for implantplacement.

4. Scan Impression/plaster model

A plaster model of the teeth was scanned using3Shape Dental SystemsTM software and exportedinto SIMPLANT digital solutions and ATLANTIS 3DEditor.

5. Implant design

The implant size and position was chosen using theintegrated implant catalogue within the SIMPLANTsoftware.

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6. Temporary Crown design

ATLANTIS designed the abutment and the core filewas sent to the dental laboratory for the CAD-CAMcrown design and manufacture.

7. Crown and Abutment

Received and tried against the teeth pre-surgery tocheck colour and general shape.

8. SIMPLANT SAFE guide try-in

SAFE guide was tried in to ensure accurate andsecure fit. The chosen surgical guide was of toothand mucosa-bourne support and is a full positionand depth guided solution.

9. Flap raised

Procedure may have been completed using aflapless technique but being the first time thissystem had been used in the UK it was decided toraise a small flap to improve vision and access forimplant placement.

10. Guided drilling

SIMPLANT SAFE surgical guided drilling ensuresboth correct alignment and depth of the osteotomy.Note the white stop on the drill which ensures thatdrilling does not exceed the correct depth.

11. Implant locator radiograph

Taken to ensure correct position and angulationsafter first drill. SAFE guide was replaced forsequential drill sequence at 1500rpm with abundantsaline irrigation.

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12. Osteotomy depth gauge

Osteotomy is measured to ensure correct depthreached . This was for illustration only and can beomitted once you are an experienced user.

13. Implant placement

Implant driver used at low speed of 25rpm andmaximum torque of 45N with ample saline irrigation.Placed slowly until notches on driver and SAFEguide are aligned. This ensures correct positioningfor ATLANTIS abutment.

14. Final implant positioning radiograph

Correct depth and positioning of Osseospeed EV4.2S x 13mm implant. Good initial stability of over35N torque.

15. ATLANTIS abutment placement

Placed to temporary restoration torque of 15N. Thescrew access is sealed with warm condensed guttapercha. Two 4.0 monofilament sutures are placed.

16. Temporary crown

Cemented with Non-Eugenol temporary cement.Occlusion checked to ensure no contact with otherteeth. Sutures to be removed after 7 days withhealing by primary intention.

17. Final radiograph

Good location of abutment to implant. Sometemporary cement visible at mesial margin oftemporary crown which was removed afterradiograph exposure.

www.dentsply.com/en-uk/implants

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