hello and welcome to chair side life I'm your host Megan strong we're so glad you're tuning
in today because in this episode dr. Byas placing implants on number 18 and number 19
he's placing the implants using the guided surgery technique so let's check out why
he chose that method and watch his process for placing the hot implants in seating to
single-unit Brooks air screw routine crowns you don't want to miss this so over to you dr. bye
hi everyone my name is dr. V and I want to welcome you back to another episode of chairside live I
want to present to you a case where a patient was referred to me by her general dentist for
the valuation and treatment of the mandibular left posterior area patients been missing teeth
number 18 and 19 for over about five years now and requires some sort of restoration
be a partial denture or implants so we had the patient come in for an evaluation and we took
a look and the clinical situation that I was presented with is what you see here I'm missing
teeth number 18 and 19 a bit of deficiency there on the buccal especially with the soft tissue so
we have to evaluate that and see what we can go with it and whether the patient needs any
bone grafting or not a good way to evaluate this obviously through clinical examination and also a
cone beam CT scan so we looked at both and came up with a treatment plan to place implants utilizing
guided surgery however there is a twist to it we reflected a flap before we placed the implant so
let me take you through the case so here I want to clinically evaluate how much attached issue I
have surrounding the teeth and in the area of the implants once we go through a digital treatment
planning we can fabricate the guide and take the patient through guided implant placement however
I wanted to reflect the flap so I reflect a full thickness flap in this situation to be
able to visualize the bone and evaluate and one of the main reasons why I'm reflecting the flap
is to help create more care of nice tissue to the buckle surrounding the implants so once the
flap is reflected I'll see the guide and this is a tooth supported guide so I'll seat it and
it has great stability and I can go through the drilling sequence create the osteotomy and
place the implants through the surgical guide each step is very important and also the most
important thing is to stabilize our guide and make sure that it's not moving while we're going
through our osteotomy drills so step-by-step we're widening the osteotomy until we reach
a point where our final drill matches the size of our implant and once we have that we can go
ahead and place the implant through the guy's so that it is a fully guided technique so here you
see our initial osteotomy once we go through with with the round drill and our start drill
and we can slowly move forward in our drill sizes and increase the diameter and length
of the drills until we reach that a final point where our drills and our implant match at the
same time that I'm drilling I'm also stabilizing our surgical guide on the teeth to make sure that
it's not moving wild world we're drilling each step is controlled in this situation to ensure
that those implants are placed exactly at the same location as we had treatment planned them
through our digital treatment planning software so here you see I've completed my osteotomy and
I'm gonna connect my Hawn implant to the implant mount and the reason I'm using the Hawn implant
is because I get extremely good primary stability and excellent Bulmer tension around the cervical
area of the implant through the years so we place the Hawn implants and remove the surgical guide
and now I'm ready to place my healing abutments now I have the option of going through either a
one stage or a two stage technique I decided a one-stage technique which means I'm placing to
transmute also healing abutment and I'm suturing around my healing abutments in order to close a
situation and make sure that the patient heals very well so one week later the patient comes
back and we do an evaluation and at that point I don't remove the sutures and this is the situation
after two weeks where we remove the sutures and the patient's tissue is healthy so now we have to
wait for a period of three to four months for osseointegration in this case I waited about
four months I wanted to make sure that those implants were fully healed and I remove the
healing abutments and now I place my closed tray impression copings now these implants are next
to each other and if I was going to splint them together I would actually splint the
impression copings together before making that final impression because these are going to be
single units and separate from each other I'm not as concerned with splinting those implants
together and any discrepancy can be adjusted with the contact points so that there is no
tension between these implants because they're not splitted together all right so we captured
the traditional final impression and now I send that to Glidewell for the fabrication of my final
restorations now this was all pre-planned and the final restorations are brookster screw retained
crowns these are hybrid restorations which means that a crown part is ruksar solid zirconia and
the connection part is a titanium sleeve that connects into the implant and the reason I chose
these crowns is because of obviously the strength and durability of the Brooks or solids or Konya
and also something that sometimes is overlooked which is the screw channels it's a lot easier to
close up and hide the screw channels utilizing the Brooks sir it's an austere amic rather than a pfm
the pfm when the patient laughs big and opens their mouth you can see the screw channels so
in this situation with the Brooks or material I'm able to close off the screw channels and
hide my screw channels because of the path of draw I want to make sure that I place one of
the crowns before the other and we practiced that before we finalized the restoration so we want to
make sure that I place the correct crown on top of the implant first and once I finalize that
restoration I can place the next implant crown on top of the implant so we have those restorations
in place and I torque them down to 35 Newton centimeters which is what's required for the
Hahn dental implant system and at this point I want to check my interproximal contacts to make
sure that there is no tightness there and I want to make sure I can pass floss through with a with
a nice sharp snap and once I have everything in place and torque down to to the 35 Newtons
centimeter value then I can go ahead and place the Teflon and the composite on top of the screw
access channels the Teflon is tightly packed in there and I want to make sure I have about
a millimeter and a half of space for the retention of my composite so I placed a Teflon and this is
the situation with Teflon in place and with the use of some bond material and packable composite
I'll go ahead and place the composite in place and shape it to the to the shape that I would like we
cure it and this is a final situation so at this point I'll move forward and check the occlusion
and make any adjustments and what we have here are two Hawn implants that are restored with
Brooks or solid zirconia crowns well I want to thank you for joining me for another episode of
chairside live and hope to see you back here soon for yet another episode thank you for that doctor
bye well that about wraps it up for this episode of chairside life on behalf of everyone here at
glial laboratories we thank you for watching and I'll meet you right back here next time