Fully Guided Full Mouth Implant Reconstruction

232 Rating(s).


Posted on By Maurice Salama In Full Arch & Dentures

A phobic patient presented to us for a Fully Guided Full Mouth Implant Reconstruction. The case was planned and executed entirely in-house using CBCT, optical scans, Digital waxups and 3D printed surgical guides and provisionals by Dr. Marko Tadros. the DIGITAL workflow is here to stay. Thoughts? Dr. Salama

Digital Workflow
Preop Clinical

Panorex Preop
Digital Guides & Provisionals


Add to Favorites
Add a comment to the discussion on Fully Guided Full Mouth Implant Reconstruction


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

25 Comments

Before & After Fully Guided protocols.

Preop
Post op


Reply

3D Printer processing guides

3D print
3D print


Reply

Which design software was used for fabrication of guides.
Did you use buccal soft tissue as replication point between cbct and models/io scans
After designing position of teeth how was this transferred to drill guides?
Thanks


Reply

Blue Sky Bio planning software was used. We stitched Dicom and STL files to gain accuracy of position of guides and provisionals. Dr. S


Reply

Hi Maurice, were these implants placed the day of the extractions? And if so, on the lower arch, after leveling crestal bone, how sure are you of the precision of your guide, as to not hit IAN or mental nerve ?


Reply

Yes, ALL the same day, immediately loaded, very precise.... New age of dentistry.


Reply

Just fabulous Maurice! Was this done open flap? Regards


Reply

No, flap was required for bone reduction.


Reply

Mo. As much as admire the skill and precision in this work flow, I fear the influence this will have on Biologically driven solutions. In this case Technology prevails over Biology. I fear these type of solutions will dominate diagnostics and treatment planning that favor pre mature loss of natural dentitions. It is a dangerous path to the future. “ if you only have a Hammer everything looks like a nail” mentality. IMO there is too much emphasis on this type of solution.
Chuck S


Reply

Chuck; I AGREE but when patients are faced with a history of decay, perio disease and expensive dentistry done in parts over an extended period of time they SEEK this solution out. Yes, in our previous days we would do everything in our power to SAVE whatever part of the dentition we could and utilize these teeth as abutments for a full restoration and they often worked for DECADES...regards Mo


Reply

Hi Chuck;
One of my favorite periodontists, Danny Melker, believes that the worst thing that implants are the worst thing to happen to dentistry because dentists no longer work hard to preserve teeth as he used to do.
Regards,
gerald


Reply

Gerald; See my response to Chuck above. I actually do agree. Worse regarding Dr. Melker's statement is that the new generation of dentists and periodontists have LOST the skills and TRAINING to perform the dentistry required to sae teeth and dentitions. IT is a slippery slope that I navigate each and every day. I do NOT take it lightly. I do my very best to discuss these treatment options with my patients.....and have insisted at times NOT to remove teeth that are salvageable. regards my friend.


Reply

Totally agree. Very nice case, planning and final results but i do think a more conservative approach on anterior teeth would have been better.


Reply

Damir; See my above responses...I do not disagree but often there are circumstances involved that the patient dictates their preferences regarding time of treatment, dental phobia, cost etc. etc.


Reply

True, Patient phobia to a multidisciplinary and extended treatment is a reality. Nice case and results.


Reply

Not sure how restorable those teeth look like???? I don't think you can get all the info from the photos to make that decision.


Reply

Excelente trabajo !! Precisa planificación y gran grupo de trabajo se necesitan para resultados como los suyos !! Mis felicitaciones a su grupo de trabajo !!


Reply

Great work as Always! All reactions are correct. Nevertheless Maurice says it all in his presentation of the case. This is a phobic patient. In these cases you need to decrease the sessions as much as possible . I am a believer in teeth preservation, but on phobic patients cases we do opt for this kind of treatments.


Reply

Marc; Yes, thank you. See my above responses. regards Maurice


Reply

Amazing precise work.
I must admit that if teeth couldn’t be incorporated at least PET would have been my choice, even if it requires 2 sedations. Hygiene is always difficult underneath this kind of prosthesis and I believe that there is less risk of periimplantitis if the ridge contour is preserved.
How was the horizontal ridge dimension lateral in low jaw?
Thank you for posting this interesting case!
Best regards
Snjezana


Reply

Snjezana; Good suggestion. This concept of PET and Scalloped Guide was discussed with Prosthodontist but due to root decay that had gone subgingivally and the rampant periapical lesions, this was ruled out. But never Ridge Lap in final and cleansible flat indiglo surface. Dr. S


Reply

Hi Maurice, Did you use a separate bone reduction guide? Could you show more clinical pictures of the surgery? Any additional bone grafting? Did you use the bone from reduction for grafting? What was the size of the implants? Fantastic case as always. Everything looks easy in your hands.


Reply

Your answers are YES, YES and YES.... Bone reduction guide YES Bone graft from reduction sites YES Implants almost routinely 3.5mm to 4.0mm regards Dr. Salama


Reply

A point that was NOT addressed yet is that THIS patient LOST his dentition due to CARIES/Endodontic lesions NOT PERIODONTAL Disease or Fracture/Occlusion.....I believe that is a critical point of discussion when attempting to hold onto remaining dentition on root surfaces that have 4X higher risk of future decay EVEN with improved hygiene/diet. Dr. S


Reply

Great case, Guys! Beautifully illustrated with perfect technique!!


Reply


Dentalxp
PET Kit