Making guided surgery and immediate protocols simpler
Featured Products Promotional FeaturesPosted by: Dental Design 28th December 2022
Dr Jonathan Dougherty, of Kilmarnock Dental Care in Ayrshire, Scotland, presents a case utilising Neodent®EasyGuide to simplify his workflow.
A 54-year-old male patient presented to the practice with a failing UR2. He was aware that what was left of the tooth would likely need extraction and was interested in replacing it with a fixed solution.
Assessment
The patient had a clear medical history, was a non-smoker and didn’t drink alcohol. A comprehensive intra- and extra-oral examination was conducted, which demonstrated no abnormalities other that the failing UR2. This tooth had broken off and only the fractured root remained. The patient’s general oral hygiene was fair, though there was some gingival recession recorded, especially in the lower anterior teeth. Existing amalgam restorations were noted on the UR4, UL4 and LL6.
A CBCT scan was taken to assess the anatomy and ensure suitability of implant placement. Intraoral scans were also taken using the 3Shape Trios scanner.
Treatment planning
All possible treatment options were explained to the patient in detail. These included doing nothing, extracting the remaining UR2 tooth root and providing a removable denture or extraction with an implant-retained restoration. The patient expressed a preference for the fixed option for optimal confidence in his smile going forward. All the benefits, limitations and potential complications of each option were detailed and the patient had an opportunity to ask any questions. He provided informed consent to proceed.
The CBCT and intraoral scans were sent to Quoris 3D for the fabrication of a surgical guide. This meant that implant location, angle and depth could be planned precisely ahead of time to ensure the best functional and aesthetic outcome for the patient. The digital impression was also used to manufacture an essex retainer for post-operative retention. The importance of on-going oral hygiene was emphasised to the patient so that he understood his role in maintaining the results.
Treatment
On the day of treatment, the failing UR2 root was extracted as atraumatically as possible. A 3.75mm x 11.5mm Neodent® Aqua implant was placed using the Neodent® EasyGuide. This facilitates guided surgery by enabling one-handed procedures and making is simpler for the clinician to achieve accurate implant placement.
A synthetic bone grafting material was placed around the implant to optimise the bone level at the surgical site, and a healing abutment was fitted. The wound was closed tension-free using 5.0 vicryl sutures. The essex retainer was also fitted during this appointment to help make sure the implant crown remained in the desired position as it healed.
The patient returned to the practice three months later for impressions and was then back again another two weeks later for the fit of the final prosthesis. He was delighted with the outcome.
Discussion
The Neodent® EasyGuide is very easy to use and facilitates a simple workflow that is particularly great for immediate implant placement cases. The specially designed drills fit directly onto the sleeve of the surgical guide and don’t need a drill handle, which makes it easier for the clinician to operate. As with any guided surgical technique, this can be very useful for clinicians wishing to achieve excellent accuracy during treatment, but it is still important to understand the analogue process first. Once mastered, the Neodent®EasyGuide makes guided surgery a simple, one-handed procedure.
Figure 1- pre treatment anterior view showing failing UR2
Figure 2 – Occlusal view fo the failing UR2
Figure 3 – Extracted UR2 tooth root
Figure 4 -Post extraction
Figure 5 – Neodent EasyGuide fitted
Figure 6 – Implant positioning checked through EasyGuide
Figure 7 – Neodent Aqua implant placed through EasyGuide
Figure 8 – EstOss sybthestic bone grafting material placed over implant
Figure 9 – Surgical site closed using 5.0 vicryl sutures
Figure 10 – retained fitted with temporary crown on UR2
Figure 11 – radiograph at implant placement
For more details about the Neodent® EasyGuide, please visit www.straumann.com/neodent
Author bio:
Jonathan Dougherty Bds, Mjdf Rcs Eng, Mfds Rcs Ed, Mfds Rcs Gla, Dip Rest Dent Rcs Eng, Dip Imp Dent Rsc Eng
Jonathan is one of the youngest dentists to hold joint awards from the Royal Colleague Of Surgeons in Glasgow and Edinburgh. He is also one of a few dentists in Scotland to hold the Prestigious Restorative Diploma from the Royal Colleague of Surgeons London. He has a particular interest in both implant dentistry and sedation, which led him to set up a referral centre in Kilmarnock for the management of anxious patients under IV sedation.
