Implant Placement and Immediate Final Rehabilitation

Once the CT scan had been obtained, implant plan- ning could proceed. The CT data was scanned and adjusted (with the toy brick serving as the baseline reference for orientation). Virtual implant placement was performed using a restoratively driven approach, derived primarily from the desired tooth position as shown by the radiopaque dental arch on the diag- nostic CT stent. Anatomical parameters, including jaw configurations and nerve locations, also needed to be taken into consideration (Figs. 31 to 35). Follow- ing adjustment of the hexapod (zero position), gyp- sum was used to mount the diagnostic stent inside the device (Fig. 36). Again, the toy brick was used as the baseline reference. In this specific case, the diag- nostic stent was inserted with the device exactly in zero position. Upon completion of the analysis, the implant3D planning software generated a list with specific parameters for adjustment of the hexapod, for the safety markers and for each sleeve position. The mounted stent can be moved in all three dimen- sions by adjusting the length of the legs (Fig. 37). Once the height stop had been adjusted with the feeler tip, the safety markers were checked (Fig. 38). If these did not agree, then the data transfer between the computer and laboratory could be considered flawed. If that was the case, then the stent would have had to be remounted with gypsum again. Prior to drilling the sleeve holes, the sleeve placement instrument was inserted in line with the sleeve, and the depth stop was calibrated to zero using the refer- ence brick (Fig. 39). The legs were adjusted to match the sleeve, the special drill was applied and the sleeve placed using a light-curing resin for stabilization (Figs. 40 to 42). Camlog Guide laboratory instruments include a tem- plate drill, placement instrument, verification pin, implant analogs, implant mounts and guide sleeves (yel- low = 3.8 mm; red = 4.3 mm). Fig. 34 Three-dimensional view in med3D with the planned implants in view. Divergent implant axes can be minimized by viewing long axial projections. Fig. 33 Three-dimensional view in med3D. Only the radiopaque arch of the stent is illustrated. The inferior alveolar nerve is indicated by the lines. Fig. 31 Three-dimensional planning of an implant at site 32 using the med3D software. It is evident that the diagnostic stent is correctly posi- tioned on the ball attachments. Fig. 32 Three-dimensional planning of an implant at site 35. If the inferior alveolar nerve is repositioned labially, an implant of optimal length can be selected. Fig. 35 Laboratory instruments included with the Camlog Guide system. EDI Case Studies 10