One day visit: some thoughts about procedures.

3 Rating(s).


Posted on By armando ponzi In CBCT & CAD/CAM

A certain number of procedures are required in order to achieve full data and items on the ‘one day visit’ concept, on a daily dentistry basis.
The accuracy on data acquisition based on CBCT and digital impression: planning for digital stent, custom abutment and provisional were provided by inhouse equipment.
The PET has been executed having in mind endodontic, surgical, and prostethic concept.
Endodontic: removal of inner part (internal canal wall and contents) and possible apex removal. Thinning of inner shield wall.
Prosthetic: shoulder prepare of 2/3 mm from gingival margin and trying to be respectful of anatomy and deciding about spaces.(a big dilemma…)
Surgical: maintaning the root part to remove, thick enough, so that it won’t break during extraction and if some area are still connected to the PET, thicker shield will break easily with no damage to the PET itself.
The technology of shield prepare is then completed by the use of Densah drill: on picture #4 the sinus membrane is easily dislocated by their use: implant apex screwed on bone below membrane enhances the primary stability required for ‘immediate loading’ (although the provisional is not in occlusion). The mesial and distal wall allowed an intial torque over 50N, required for immediate load osteointegration success. (see BIC# picture)
Still on picture #4 an interesting ‘Densah effect’: the change of inner surface quality: from rough initial one to smooth final one. Could that be beneficial for healing phase?
The abutment, one time custom, allows two define to major accomplishment:
-One time healing concept.
-Phisiologic healing with an elliptic prosthetic plattform and relocation of prostetic margin in a superficial area with easier and reliable cement removal.
Skill may be required to place implant in the range area together with the abutment and provisional. (some digital items can be used to improve predictability)
It is now possible to have abutment and crown in a post production way, using digital technology,possibly inhouse
These experiences about the ‘on day visit concept’ on daily dentistry basis, will be shared on international Versah Meeting (OWS) on January 12-14 2017 in Orlando. http://ows.versah.com/
Armando


custom abutment immediately placed
PET: initial prep

shield prepare
palatal root fragment


Add to Favorites
Add a comment to the discussion on One day visit: some thoughts about procedures.


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.

22 Comments


Reply


Reply


Reply

immediate Xray control


Reply

Hi, how are you able to manufacture abutment same day? is this in an office mill? We have an E4D scanner in office and wondering about using stock abutments but that could 'pinch' on the shield etc..


Reply

Hi Mark, the abutment you see here has been made in advance: on the surgical stent planning the abutment is created over the planned abutment (Virtual position). Skills are required to place actual implant same position. In post-production you take an intraoral scanning same day (scan transfer on implant)and then produce the abutment using a milling machine in house. Hope I was sufficiently clear. Best regards. Armando


Reply

Hi Armando

The future is now! Very nice use of technology.

Do you have a intraoral photo at Day 1?

Look forward to attending your lecture in OWS.

Emil


Reply

Armando,

spectacular!- you have done it- very detailed- so to summarize- you planned to place the implant palatal to amount of root thickness you expected to leave- say 1.5-2.0mm- you controlled the depth and length of implant based on where sinus located- concomitantly this allowed you to design depth of abutment fabrication- you designed the buccal contours of the abutment to " avoid" contact with the shield- Cement retained provisional so as to not have to unscrew provisional risking additional force?

Any grafting of gap? What do you section your roots with- How long will you wait to finish case

just magnificent

Cheers,

Richard


Reply

Richard, the idea is to plan digitally and try and stay on the planning limit when doing surgical phase. The insight from planning allows to understand better the surgical areas, in terms of shield limits. The surgical stent allows to establish implant direction and depth. I didn't place any biomaterial. One thought to share with you about when placing the definitive crown: woven bone is called 'immature' but what are the stimulus for it to become 'mature'? Just time? Hope to see you and talk to you in Orlando. Best. Armando


Reply

Emil, thanks for kind word my friend. I actually found out I don't have one. I will post the 10days control. I will be very happy to meet you in Orlando. Armando ps.(is Marisa coming too?)


Reply

Armando:
"Now the cat is out of the bag". Are you still planing on sharing the full detailed protocols (anterior, posterior, single, multiple) in January at the OWS in Florida? How easy it is going to be to incorporate the C-guide in this protocol.

Salah


Reply

Armando, very well case design and digitall preparation. How was the abutment prepared in your office? Wow.
Please add more clinical pics of the case.
I won´t miss your conference at OWS january.
See you.
Jorge.


Reply

Jorge, thanks for kind word. We've got a lot to share, so looking forward meeting you in Orlando. The abutment is produced inhouse with a milling machine and a premilled (a block of titanium with the implant connection): Stefano is projecting everything, You should join the club these days...(*__*). Take care. Armando


Reply

Armando; Great case; My only concern is the failed endo in the tooth mesial to the implant. Regards, Gerald


Reply

Gerald, thanks for kind word. I agree it is a concern. Best regards. Armando


Reply

Armando. Beautiful flow of treatment! I expect nothing less from you :-). If a patient fractured a tooth tonight and walked into your office tomorrow at 9:00AM could they leave the same day with this result? BTW what is your desired gap distance between the shield and abutment? Does it differ within the socket vs. occlusal? OWS is to be a unique learning experience to say the least. See you soon. My friend. Chuck.


Reply

Chuck, if a patient comes in he/she will receive a CBCT and a digital impression: everything starts from there. IF DATA ARE ACCURATE, my friend, just surgical stent and 3D printer requires few hours, so it needs to be done at night time. Everything else, abutment and crown can be done on milling machine less than an hour! You quote: 'BTW what is your desired gap distance between the shield and abutment? Does it differ within the socket vs. occlusal?' That's a million dollars question, my friend!!! But we both know how vestibular margin varies and makes all measurements non standardizable.. Will be great to have your valuable thoughts on the matter in Orlando. Look forward to that. Best. Armando


Reply

I am adding a control and another detail about the planning step that leads to surgical procedure on 'one day visit'

7 days healing
Virtual abutment over virtual implant position


Reply

Armando

Thank-you for posting the photo.

Very,very nice.

Emil


Reply

Emil,
Thanks for kind Word.
Armando


Reply

Armando,

Thank you for additional info- At the end of the day, time is all we have... Maturation of bone, a result of function..stimulation- is that not what we see with tissue and why we attempt to preserve- Digital Biology my friend

Orlando may be a tough one for me- Am trying my best.

Cheers,

Richard


Reply

Martin, I like a lot this new concept of 'digital biology': I agree with you there's multilevel new concept based on data integration. Hope you can make it for Orlando, lot's to share my friend. Armando


Reply


Dentalxp
Brasseler