Dentaltown July 2017 - 54

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8: Occlusal view of final crown.

Fig. 9: Retracted MIP.

in the guide, the longer twist drills used by
the Simplant system couldn't pass through
the guide because of the patient's small
mouth and limited opening. As a result, I
was unable to use the guide for anything
more than the initial punch osteotomy.
The guide was removed and, following the
Astra Tech EV protocol, the #1 twist drill
was used to prepare the initial osteotomy
to a few millimeters' depth. A periapical
radiograph (Fig. 4) was taken to check
positioning and angle.
After verification of the position and
angle of the osteotomy, the remaining twist
drills were used per Astra Tech EV protocol
to prepare the remainder of the osteotomy.
Type II bone was noted, so the A twist drill
followed by the V twist drill were employed
to complete the prepared site.
The implant was placed in the site
with a final torque value of 40Ncm; a
HealDesign EV 6.5mm healing cap was
placed on the implant, and the site was
sutured with 4-0 chromic gut sutures. A
final periapical radiograph (Fig. 5) was
taken, and then postoperative instructions
were given to the patient before dismissal.
Sutures were removed at the one-week
follow-up appointment, when excellent
soft-tissue healing was noted.
Fifteen weeks later, the patient returned
to the practice for restoration of the implant.
The healing cap was removed and an

impression was taken using an open-tray
impression coping and PVS impression
material (Fig. 6).
A gold titanium Atlantis custom abutment was selected for the restoration with a
screw-retained, high-translucency zirconia
crown that the lab had cemented to the
abutment using a dual-cure resin cement.
The crown was inserted into the implant,
occlusion and contacts were verified, and
the crown was torqued to its final value of
25Ncm. A final periapical radiograph was
taken (Fig. 7), and the screw access was sealed
with Teflon tape and opaque composite.

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54

JULY 2017 // dentaltown.com

Conclusion
Overall, this case offered me an enormous
learning opportunity. Despite the planning,
sometimes there will be cases where you're
forced to think on your feet. Being unable to
use the guide that I had spent so much energy
designing was one such unforeseen situation;
fortunately, I had over-the-shoulder assistance
of my principal dentist and my local Dentsply
Sirona rep to help me through it. Despite
the issues during the surgery appointment, I
was pleased with the final result of this case.
I am immensely grateful for the mentorship I am so fortunate enough to have in
my office. It has allowed me to push myself
to do things that I may have hesitated to do
otherwise. Although I'm still a novice dental
practitioner, I'm excited to keep learning. ■
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