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Sponsored Case: Planning to Placementâ€¦ A Seven Day Success

Last Updated: Dec 04, 2013

Case Sponsored by 360Imaging: Your total solution for 3D implant planning and surgical guide creation. Learn more at: www.360imaging.com/

Case presentation by Dr. Bart Silverman (Oral and Maxillofacial Surgeon)

Dr. Silverman is in private practice limited to Oral and Maxillofacial Surgery in New City, N.Y. and is an attending Physician at Westchester County Medical Center, Department of Dentistry. He is also a Clinical Associate Professor at New York Medical College. He lectures nationally on several different implant systems and is President of the Bi-State and Hudson River Implant Study Clubs. He is a past president of the Rockland County Dental Society and previously served on the Board of Governors of the Ninth District Dental Society

Case Background and Images

The patient that presented was a 56 year old male with a history of sleep apnea, anxiety, and obesity. Because of the patient™s history, I wanted to minimize the time under anesthesia and complete the case as efficiently as possible. The prosthetic plan was to deliver 6 implants for a final result of a fixed hybrid. The patient also chose to keep two left molars with a bridge. I decided to go with guided surgery in order to improve the use of my time and ensure a predictable outcome. The guided surgery was completed in 1/3 the time that it normally takes to place six maxillary implants. This savings allowed me to reallocate time that would have been lost, to additional surgeries. The patient returned for post-op two days later with minimal swelling and minimal pain. Most importantly, the patient was extremely happy with the surgery. We will restore the case in approximately 4 months and will continue the story.

![]Panoramic image post maxillary extractions](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/12/360case1.jpg)Panoramic image post maxillary extractions
![]Six implants planned in the 360dps software](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/12/360case2.jpg)Six implants planned in the 360dps software
![]360ips guide (implant positioning system).](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/12/360case3.jpg)360ips guide (implant positioning system).
The guide is a Thommen implant specific surgical guide with fixation for additional stability during surgery.
![]The 360ips guide fixed to the patient](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/12/360case4.jpg)The 360ips guide fixed to the patient
![]The Thommen guided drill and narrowing tool inserted into the surgical guide for angulation control and depth knowledge. The depth knowledge is based on depth corresponding lines on the drill.](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/12/360case5.jpg)The Thommen guided drill and narrowing tool inserted into the surgical guide for angulation control and depth knowledge. The depth knowledge is based on depth corresponding lines on the drill.
![]A post implant placement panoramic image.](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/12/360case6.jpg)A post implant placement panoramic image.- - - - - -

![]](http://www.360imaging.com/)
Case Sponsored by 360Imaging: Your total solution for 3D implant planning and surgical guide creation. Learn more at: www.360imaging.com/ or Call us today at 866-360-6622 to see how our solutions can improve your outcomes.

6 Comments on Sponsored Case: Planning to Placementâ€¦ A Seven Day Success

New comments are currently closed for this post.

Dr. Alex Zavyalov

12/12/2013

From the final 2D X ray the implants were installed rather well, but without the left lower jaw restoration (not mentioned) it will lead to unilateral mastication loading.

CRS

12/13/2013

That comment doesn't make sense since it is a well executed case with first premolar occlusion and a restoratively driven implant placement. I bet that bridge will eventually be removed when it fails along with the failing endo on #31. Perhaps that posterior bridge is being used while the patient is healing as part of a staged treatment plan, I know I would. It doesn't make sense to place post implants at this time to align with an old bridge, staging is a good plan. My question for Dr Silverman is Did the patient have a scan appliance made by the restoring dentist or was it computer generated ? I struggle with having a good restorative treatment plan generated by the dentist vs doing things piecemeal. Perhaps this software could compensate for this problem. With multiple implants Ct generated guides are great. Was this done flapless? And what type of CT scan was used? Thanks.

CRS

12/13/2013

Also one other question how was the temporary prosthesis managed to prevent bone resorption?

Richard Hughes, DDS, FAAI

12/14/2013

CRS, Alex's comment does make sense. There would be a loading on one side. The lower left should be restored and the curve of Spee leveled if needed. Bicuspid occlusion is ok but why not improve the occlusion.

CRS

12/14/2013

I understand but my point being that bridge is iffy look at the second molar. My point is sometimes we try so hard to work with old natural restorations that end up failing within a few years of implant placement perhaps compromising the placement. However old work is of benefit in holding vertical dimension, staging and temporization. I see this a lot in my practice and the patient needs a heads up that these restorations may fail to incorporate it into the overall treatment plan. I agree that side of the mouth will eventually need reconstruction just don't base it on old restorations. That bridge is probably holding since it has no opposing teeth! And I don't like to remove natural teeth prematurely just don 't want the implants to be at risk. And I absolutely respect your opinion on restoration and rely heavily on it since the surgery is restoratively driven. Thanks always for the imput and hearing my take on these cases from the surgical viewpoint.

Richard Hughes, DDS, FAAI

12/15/2013

Yes, CRS. Now you see the point. I would treat this case by a staged approach. Establish vertical. Remove any questionable teeth, place as many implants as needed and restore with provisionals, evaluate occlusion, esthetics, phonetics, then proceed to definitive prosthesis.

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