A mininvasive procedure with surgical stent.

7 Rating(s).


Posted on By armando ponzi In CBCT & CAD/CAM

A patient was studied to replace the upper right quadrant. A surgical stent was used for minimal invasive procedure (the patient age 79, is under anticoagulant therapy).
Implant #16 was planned just next to the sinus membrane and first guided drill was used to determine the length and direction (7mm).
Versah drills were then used to elevate the sinus for 3 mm: that was done in a quite simple way and with comprehensive haptic effect: implant placed was 10mm long.
IMO, surgical planning, with surgical stent can allow easy clinical procedure with positive effect either on surgical procedure (reduction of time, anesthetic dosage and bleeding ) or on postcare follow-up (basically no swelling,no pain,no bleeding, no sutures).
Versah drill, can be used to quickly and reliably solve sinus elevation for 3-4 mm, allowing the use of longer implant.
Thank you.

surgical stent
Initial guided drill based on planning

implant relation to sinus on digital planning
Versah drill used to lift sinus


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15 Comments

Armando; great case. This is the ideal case for digital planing and flapless approach. What a great service for your patient. Congrads!
Yiannis


Reply

Yannis, thanks for kind words. I agree with you digital and flapless are going to be new frontiers of next future considering we place implant to very old people now (my personal record is 13 implants on 94yrs old patient , no other ways than flapless on a private practise ) Best regards. Armando


Reply

Armando:

Welcome to Osseodensification my friend. Site Optimization with minimum invasive implantology is the future.
IMO, The key is to have the predictable stability, regardless of bone starting density, to deliver the restoration at the same day. What was your insertion torque values in this case?


Reply

Dr. Ponzi, awesome case! I have used CT guides with densah drills on a few cases recently. On my guides, the sleeve is 10mm. The versah drills max out at 20mm? So you can place up to a 10mm implant through the guide with total control still. The drills designed for the guide are straight, not tapered like the densah drills are, so it makes it slightly more difficult with that guided system, but still fairly straightforward. I need to take pics next time. But I totally agree with you, flapless if possible (3mm of kg circumferentially around fixture) and fully guided. Makes it efficient and safe. -Jonathan


Reply

Jonathan, great issue the one about surgical stent and Versah drill. I believe that a Universal stent engeneered for the Versah could be an important implant daily dentistry basis implementation. Dr. Huwais should tell us any information on the field. Because of limitations you mentioned I used the Versah drill NOT guided on last implant. Best regards. Armando


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Salah, I'm doing great things with Densah drill that I think are invaluable in such a situation. I did not focus on insertion torque as I did not planned for immediate loading. My clinical impression is that Densah works very well on implant diameter from 4.2 on. What do you think about that? Thanks for comments. Armando


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Armando, nice job. The Densah burs makes the process as you say very confident and easy. The stent is the perfect mate to do things right. How long did it take the whole surgery?
Regards.
Jorge


Reply

Armando

Very nice.

The anatomy in this case -----wide ridge, abundant KT was very much in your favor.

Digital dentistry is here and we must embrace its benefits.

Thanks for sharing

Emil


Reply

Emil, I totally agree with you digital planning is the future way of placing implants. Warm regards. Armando


Reply

Jorge, thanks for your word. Actually the surgery is quite fast, less than an hour for the four implant. The interesting fact is that it is a no stress procedure for the patient and the operator. Look forward visiting you in Madrid. Armando


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Thank you for sharing your case! I see your implants position are in different places. Did you plan your guide according future restorations or according to available bone? Gregory


Reply

Gregory, good question. on the planning I have set some virtual teeth as you can see, just to have a clue of prosthetic. On large or specific case I prefer to have a real digital planning in occlusion, that I transfer on the planning and have a superimposition between implant direction and prosthetic. I've post two photos about that. Thanks for the comment. Armando


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Thank you!
Regards,
Gregory


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Armando. EQUISITE treatment plan and execution! My complements! I use Densah burs on a regular basis and also notice the primary stability improves as you widen the site with osseodensification. If desired, you may increase primary stabilization in a narrow site by adding allograft and repeat OD drilling with the same size Densah bur. BTW I am not aware of any protocol or studies using Densah burs with the flapless approach. I would imagine some soft tissue will be displaced in an apical direction? Probably insignificant, but still should be examined. It appears we need to re write the book for implant site preparation. I look forward to meeting you in Madrid. Warm regards. Chuck.


Reply

Chuck, you are a great clinician and I like your mind workflow. You are right, I thought of that when doing ossedesification flapless so, I took a blade put on the osteotomy and cut gingiva all around and make sure no contact between tisse and bur. Implant was 4.0 in diameter so, last bur was the VT2830. Although I'm not so sure, about ability of burs to display soft tissue inward. Good idea to place the allograft and combine it with densah to improve the primary stability. Definetely looking forward meeting you on Madrid. Take care. Armando


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