hi everyone and welcome to episode 161 of chairside lies I'm host Megan
strong and I'm glad you're tuning in today because we have a great show dr.
Anna Maria Mira Shawn will take us through an implant case featured in
this issue of chairside magazine this case is all about providing implant
treatment in protecting dentition with an astronaut coucil splint let's take a look
for this implant case I would like to start by saying that it was an implant I placed soon after
I graduated dental school and because of that I had to rely either on a relative or my best
friend for that kind of trust from my patient besides I was very lucky to have doctoral buy as
an innocent bystander to watch over the procedure so here is my patient Norah a young woman that had
an adventurous space associated with the area of tooth number three a removable partial denture is
thought function and maintained interproximal and intercostal space for a while until she decided
she was ready or she trusted me enough to replace her partial with a fixed implant restoration after
periodontal treatment to replace the missing tooth I planned a single stage surgical protocol
for the implant procedure on Nora's case I used the inclusive tapered implant a screw retained
Broxson anterior crown to replace number three and a Astron bite splint to help protect patient
and Titian from para functional habits I chose braixen interior for the implant crown because
this material has averaged flexural strength of 650 mega Pascal's prior to the implant placement I
use cone beam CT to acquire the three-dimensional images to evaluate the prospective implant site
a two millimeter thick radiographic stent that had a three millimeter drill opening
for good aperture helped me gather information about the location of anatomical structures in
relation to the planned implant site alveolar Ridge measurement using bricks on 3d viewer
predicted optimal buccal lingual mesial distal and apical implant position also help visualize vital
anatomical structure and help me decide if any bone grafting will be necessary at the time of
implant placement based on this three-dimensional data I was able to accurately measure the height
and the width of the bone and the exact size implant I want to use I chose a 4.7 millimeter
by 10 millimeter inclusive tapered implant and I felt comfortable with 10 millimeter length
not only to stay away from the eye a nerve but also from the submandibular depression following
appropriate anesthesia I made a crystal and circular incision and use a pure steel elevator
to raise a full thickness flap to help find proper position for the initial drill I start preparing
the osteotomy using a surgical stent initial perforation of the alveolar Ridge was done
with a point five millimeter diameter lens trail for the surgical drills that followed I felt that
I was struggling to see the black markings on the drills so I decided to continue the
osteotomy without a surgical stent to increase my visibility to check the orientation of the
osteotomy I took an x-ray with a parallel pin in place after confirming the proper position
I continued to widen the osteotomy proceeding to the final drill the implant was threaded into the
osteotomy at 15 rpms until fully seated this implant had internal hex connection with a 3.5
millimeter platform and the recommended placement is at the bone level to verify primary stability
of the implant I use a hand torque wrench and you can see here is indicating about 35
meter centimeter to prepare the implant site for healing I selected a 4.7 by 5 millimeter healing
abutment the final radiograph confirmed proper sealing of the healing department as well as
the positioning of the implant in the alveolar bone once the healing abutment was placed I use
simple interrupted gore-tex sutures which plans to remove the sutures after 14 days and allow
12 to 16 weeks for austere integration during the healing phase the patient continued to use
her previously made a strong bite splint after allowing the implant to Austin great the patient
returned two months later for the final impression appointment at this time I took the shade prior to
removing the healing abutment and after removing the healing abutment the impression copying was
torque into place an x-rays confirm that the transfer coping was seated correctly Here I am
syringe in the impression material around the impression copying preparing to take the final
impression using a clothes tray impression technique the impression was sent to the lab
for the fabrication of a screw retain implant supported Proctor interior crown in shade a3
at the delivery appointment the healing abutment was removed and Here I am using chlorhexidine to
rinse out the site prior to the inserting of the crown because of the concern about the risk for
peri-implantitis due to the residual cement when aesthetics and occlusal considerations
permit I prefer a screw retain instead of cement retained crown the final crown was delivered with
the torque of 30 Newton centimeter interproximal contacts were rechecked and to cover the access
hole I use teflon tape and camouflage Nano hybrid composite occlusion was tracked with one tape shim
stock slight occlusal adjustment were necessary to obtain one tape of shim stock out of occlusion
after delivering the crown successfully the patient previously made a strong bite splint was
adopted chair side by immersing it in hot water to provide ideal feet with her new bronzer interior
restoration in place the astral buy splint still continued to be no clues all device of choice
thank you for that dr. Moreau Sean well that about wraps it up for this episode of chair
side lie on behalf of everyone here at Glidewell laboratories we thank you for watching and hope
you'll come back next week we got no prompter now Dee Dee deep Dee there's no prompter on this
camera that's why I'm not doing it anything go greased hog Nitin butter butter burn
you