hello and welcome to chairside live I'm your host Megan strong in today's show dr. chi is
placing his first implant he's placing a Hawn implant in a den Sheila's site number 30 he's
following through the straightforward protocol of the Hahn surgical kit and then the final delivery
of a Brooks or anterior screw retained crown dr. chi saw yours Thank You Megan for this case of the
week I'll take you through the clinical procedure of the placement and restorative process for my
first implant case that I introduced in episode 213 my patient is a healthy 38 year old female
that had her lower right first molar number 30 extracted in 2008 and restored with a fixed
partial denture from 29 to 31 a few years later she was convinced to remove the ponic and attempt
shifting that second and third molars medially with Invisalign to close the space after only two
months she stopped the orthodontic treatment in favor of an implant in the future the old abutment
crowns on 29 and 31 were replaced by dr. Bai with these beautiful Brooks er anterior restorations
despite the mesial drift of the second and third molars dr. Bai was able to create enough space and
a proper path of insertion for our future crown intraoral and radiographic examination allows us
to determine the dimensions between the adjacent teeth and surrounding bone that will allow us to
select which size implant were able to play safely and predictably following a general guideline of
establishing at least one and a half millimeters between the implant and adjacent teeth and two
millimeters from the nerve I select a Hawn 4.3 by 11 and a half millimeter implant a Ct is an
invaluable tool as we can get a three-dimensional digital visualization of the chosen implant within
the attention space after setting the planned position in the software I have an estimated
three millimeters or more between my implant and surrounding structures safely within the
recommended guidelines now on to the placement after administration of local infiltrations I
create a mid crystal full thickness flap so I can visualize the bone beneath to reflect the
soft tissue enough I extend the incision to the mesial-buccal and mid lingual of number 29 and the
distal buccal and mid lingual of number 31 once reflected I begin the osteotomy with the first
twist drill that's one and a half millimeters in diameter ensuring that I'm entering the bone
parallel to the long axis of the adjacent teeth the second twist drill in the sequence is one
and a half millimeters at the tip and increases in diameter to two point four millimeters near
the coronal half to begin widening the osteotomy with the parallel pen in place I take a radiograph
to verify that I'm in the correct position minor corrections to the angulation can be
made using the subsequent shaping drills or a side cutting burr such as the liniment drill since no
modifications need to be done I move on to the 4.3 by 11 and a half millimeter shaping drill in
the Hahn surgical kit once the shaping drill has been placed to the proper depth it's now time to
place the implant within the osteotomy I dial the handpiece speed down from 800 to 25 rpm to
carefully position the implant slowly once fully seated and primary stability is achieved I place
a three millimeter healing abutment that the soft tissue to heal around it once the healing abutment
is placed I place a couple of interrupted chromic gut sutures to achieve primary closure of the flap
after four months of healing it's time to take the impression for the final restoration I removed the
healing abutment and place a scan body since I will capture the impression digitally using three
ends true definition scanner I apply a thin layer of contrast agent to the abutment and surrounding
tissues for the scanner to acquire the interval information that's needed to fabricate this
restoration as I move the scanner around the area I watch the screen as the system provides instant
feedback while I captured the occlusal and buccal and lingual surfaces all digital impressions act
like a digital triple tray requiring a scan of the prep area opposing dentition and bite so the
lab can establish the proper occlusion for the restoration once all the scans are completed for
the digital impression will then send this file over in our digital prescription to the laboratory
after a week of fabrication we receive our screw retain Brooke sir anterior crown once
the proximal contacts are evaluated and a complete seeding is confirmed with a
radiograph I then torque the crown down to 35 Newton centimeters to begin the bonding process
I'll place 3m Scotch bond universal and then likeyour that for 10 seconds and restore the
rest of the access hole with camouflage flowable composite since there's no apical mobility like
with natural teeth we want to adjust the occlusion until there is a shim stock drag and not a hold
to avoid excessive occlusal force the patient loved how the screw Brook sir anterior crown
provided a perfect blend with the adjacent restorations to clarify Brock sir anterior
is a more translucent version of monolithic Brook sir offering a high flexural strength
of 650 mega Pascal's its optimized for anterior applications but is definitely strong enough for
posterior indications if proper preparation guidelines are followed if you haven't taken
the steps into implants yet I'm confident with the right training and usage of an easy system
like the Han system you'll be able to provide your patients with this treatment modality in
the future thank you for tuning in to watch my journey through my first complete implant case
we'll see you on the next episode back to you Meghan thank you for that dr. Qi and if you'd
like to see the first part of this case you can watch episode 213 of chairside live to do that
and you can head over to chairside live.com or find us on youtube or itunes and watch
that first part of the episode to get the whole experience of placing that first implant well
that about wraps it up for this episode of chairside live on behalf of everyone here at
gladwell laboratories thank you for watching and I'll meet you right back here next time
you