Full Upper Implant Bridge | DSD - Guided Implant Placement | PET | Densah . Part 1.

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Posted on By Anton Andrews In CBCT & CAD/CAM

Digital Smile Design, Digital Implant Planning and Guided Implant Surgery had been utilized during the planning and the first surgical treatment phase of this complicated case.
Specially designed segmental incision, tunnel bone grafting (PRP-enriched) along with the digitally produced surgical guide allowed the most conservative surgical approach to be used.
The result was quick healing and minimal post-operative discomfort experienced by the patient.
HD version could be watched here:
https://youtu.be/sA00u-V87_g
It was my first guided case and it went so smooth and confident that I do not see myself going back to perform similar treatments "the old way".
Critics and comments are welcome.

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12 Comments

This video is available in HD here http://youtu.be/sA00u-V87_g


Reply

Hi Anton,

Nicely done. I think more and more doctors are realising about the potential of guided surgery. I'm of your same opinion, would not undertake this cases the conventional way. Some much guess work is eliminated.

I have been using guided surgery for 5 years now, and softwares are getting much better.

One question, did you stabilise the guide just with the molars?

Waiting to see the restorative phase

Regards


Reply

Thanks Andoni,
the guide was stabilized over molars and the palatal torus for tripodization. The next step will be #3-13 screw retained temp bridge on 4 and 2 molar implants placement. This case is planned for all-on-6


Reply

Anton,
Your skills are outstanding!
How did you temporize this case and if a full denture was used what gives you space maintenance of your anterior bone graft ?


Reply

Thank you Laurent,
I used the existing upper partial for temp. The vestubular flange was trimmed to prevent pressure on the grafted area


Reply

Anton. Very thorough planning and execution. My compliments! Digital planing is a big plus here. It is certainty difficult to make all this many decisions at the time of surgery. I have a couple questions about your grafting protocol. 1) How did you determine the RPM and amount of irrigation for osseodensification of the allograft?
2) Why not perform the tunnel grafting prior to the Ossodensification of the alloplast and implant placement?
Execellent case for learning and discussion. IMO it clearly demonstrates the value and simplicity of PET philosophy compared the more elaborate and invasive Total Extraction / Repair approach.
Thank you for sharing. Warm regards. Chuck


Reply

Thank Charles,
The allograft densification was only done in the incisal canal with 125 rpm in reverse, without irrigation.
As for timing of the tunnel graft , do you mean , doing it first during the same surgery or in two visits?


Reply

First during the same surgery. I realize you prefer to avoid multiple surgeries in the same regions.


Reply

My sequence for this case was the following:
prep the tunnel first, in order to avoid damage of the periosteum and epithelia with osteotomy.
Finish osteotomies with Densah burs for the expansion and propelling bone particles apically in the perforates area.
Finish with the tunnel bone graft placement.
I hope this rationale seems logical.


Reply

Part 2.
http://youtu.be/-pqA-tBNRyA


Reply

Finished case


Reply

Model-less workflow


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