GAP Australasian-Dentist-Mar Apr 2019

Category 60 AustrAlAsiAn Dentist implant position, including depth control and implant timing. the prosthetic components of the case also were planned at this time. the simplant file registering all of the positional attributes of the implant was then imported into the Atlantis Abutment software by selecting the immediate smile protocol option. this allows a final abutment to be designed from the proposed implant plan. A fully anatomic patient-specific abutment in gold-shaded titanium was selected to achieve optimal soft tissue and prosthetic support. 13 the digital file representing the abutment was then exported via an Atlantis Core File and imported into the 3shape software to design an acrylic resin interim prosthesis. the surgical guide, patient-specific abutment, and interim prosthesis crown were all manufactured and returned prior to the surgical date (Figure 6). the patient returned for her surgical visit and consent was obtained. tooth no. 8 was extracted with the aid of periotomes maintaining the integrity of the buccal plate. the socket was curetted and irrigated with sterile saline and the simplant sAFe Guide was placed. the assessment of the surgical guide’s intimate fit to the teeth was verified by creating occlusal and proximal windows, allowing for visual inspection to assure the guide was seated (Figure 7). the Osseospeed eV guided surgical kit (Dentsply sirona implants) was used with full depth and location drilling control. the implant was placed through the guide to its proper depth (Figure 7). An insertion torque of 35 ncm was achieved and verified by the surgical motor, allowing for adequate initial stability for immediate loading. the timing of the implant was attained by assuring the large notch on the implant driver lined up perfectly with the channel index line on the surgical guide (Figure 8 through Figure 10). Due to the immediate nature of the implant placement, a facial gap was evident between the implant and the alveolar process. A xenograft material (Bio-Oss, Geistlich Biomaterials, geistlich- na.com) was placed to fill this gap accord- ing to established protocols. 14 the Atlantis custom abutment was then placed in its proper position and the seating was veri- fied with digital radiography. the abut- ment was torqued to 25 ncm, as per the manufacturer’s specifications (Figure 11). the interim prosthesis was then placed onto the abutment and slight adjustments were made. A final custom stain and glaze was placed on the interim prosthesis crown using lite Art coloring pastes (shofu Dental Corporation, shofu. com). the provisional was cemented with tempBond ne (Kerr, kerrdental.com) and was relieved of any excursive contacts. the patient was given post-operative instructions and left in extremely high spirits (Figure 12). Conclusion in today’s fast-paced world, where patients and clinicians are demanding very efficient and practical treatments, being able to leverage the technology available with the immediate smile featuring Atlantis abutments protocol is a must. it allows us to examine the current state of the proposed implant site, visualize the future restorative ideal, plan the implants accordingly, and execute very precise guided surgery. the ability to then use this plan to design and manufacture the final patient-specific Atlantis abutment and a milled interim prosthesis pre-operatively simplifies the clinical and laboratory processes associated with the final step of immediate provisionalization. All of this leads to more efficient productive treatment for all parties involved. u References available – email: gapmagazines@optusnet.com.au lInICal Figure 5 Figure 7 Figure 6 Figure 8, 9, 10 Figure 12 Figure 11 See Dr Ludlow at the 38th Australian Dental Congress Wednesday 1 May 2019 Integrating digital dentistry 360 Workshop Thursday 2 May 2019 8.05 – 9.00 am – Hall D The art and science of the fixed edentulous patient 1.45 – 2.30 pm – Hall C ADELAIDE For more information, see www.ada.org.au Figure 3 Figure 4