using cbct for side by side implants

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Categories ; Posterior, CBCT, multiple implants, Nobel Biocare,

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There is bone , but is it in the right place for our prosthetic needs ?

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cbct

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VPS Is radio opaque, a small impression (or a full arch impression) worn during

CBCT scanning allows visualization of the soft tissues in relation to the bone.

Transfer to the cast is simple

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A small VPS bite registration material impression can be made if the patient has

to go to an external radiology center.

If the CBCT is in the office, then a scan can be made while the full mouth VPS

impression is still in the patients mouth, even if the impression is still setting, so

no time is lost. Note ; these images are from another patient.

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# 21 site # 20 site

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A pinhole is drilled to place the top of the implant, in this case sub-

crestal to allow sufficient room for the emergence profile

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BLP’s in place. The BLP will lock in the bucco- lingual position and the top of the

implant. It still allows precision adjustments to the mesio-distal placement

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Wings cut from the buccal and lingual wings for site by site implants

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Note the buccal space for flap reflection

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0 degree ( green ) rotation blocks ( RP) in place

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Correctly exposed radiograph, indicates reliable diagnostic interpretation; no

need for correction , so use 0 degree ( green ) rotation-blocks

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Guided surgery does NOT mean flapless surgery, mini-flap allows transportation

of attached tissue towards the buccal

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Final osteotomies

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Implant placement. Note that because the ridge was not flattened as is common

in non guided surgery the implant # 20 appears to be placed deep. This is

however exactly as planned to get adequate buccal bone coverage. The guided

bone-mill is used to create space to place the healing caps. The body will resorb

as needed.

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Sub crestal placement exactly as planned per prosthetic outcome and bone

availability

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Initial ISQ , allows monitoring of osseointegration

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Attached tissue is positioned buccal of the healing caps.

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Guided and delivered as planned