CAD0111

I 11 case report _ guided implantation I CAD/CAM 1_2011 jaw before treatment. The patient categorically turned down any augmentation. Owingtothepatient’sstrongpharyngeal(gag) reflex and the desire for the highest possible level of safety, short incapacity periods and minimal restrictions during and after implantation, the restorative team in consultation with the patient opted for backward planning, combining intra- oral scanning and CBCT. Method 1. 3-D X-ray imaging using CBCT: A 3-D X-ray scan was taken with GALILEOS CBCT. For fu- ture referencing, a standardised radiographic template(SICAT)wasusedduringtheX-rayscan. The template with radiographic markers was fixated in the patient’s lower jaw using bite registration material (Futar Scan, Kettenbach; Fig. 2). 2. Intra-oral scan for implant planning: An intra-oral scan of the second and third quadrants including a vestibular scan was taken with the CERECACBluecamduringonesession.Acrownin region 36 (Fig. 3) was then designed based on the virtual model. The optical impression and the virtual crown were exported to be combined with the 3-D X-ray scan in the implant planning soft- ware (SICAT Implant). 3.Intra-oralscanofentirejaw: A further intra- oral scan of the entire upper and lower jaw (Fig. 4) was taken to produce a physical model for the creation of the surgical guide at SICAT. The intra- oral scan was sent to the LMU Department of Prosthetic Dentistry’s laboratory via the CEREC Connect online portal, which ordered a stereo- lithographic (SLA) model. Tobegintheimplantplanning,theDICOMdata from the CBCT and CAD data from CEREC was im- ported into SICAT Implant. Using neighbouring teeth as markers, both data sets were then super- imposed and merged (Figs. 5 & 6). On the basis of this information, the 3-D planning procedure took place following bone and prosthetic re- quirements, in compliance with safety distances. The exact gingival margin displayed within the software helped to determine the soft-tissue situation, allowing precise planning of the emer- gence point (Figs. 7 & 8). In the present case, the dental team opted for the navigated placement of a Straumann Stan- dardImplantwitha4.8mmdiameter(Straumann Guided Surgery). Once planning had been com- pleted, the planning data was burned onto a CD and sent to SICAT along with the SLA model, radiographic template and order form. The company uses the planning data to trans- late the radiographic template into a surgical guide (Figs. 8–11). Before delivery, the surgical guide is tested using high frequency testing in order to ensure that it meets the manufacturer’s guaranteed production accuracy of less than 500 µm at the apical end of the implant (Fig. 12). With the surgical guide, the dental team re- ceived a surgical protocol indicating which drills and sleeves of the Straumann Guided Surgery Kit to use. In order to ensure a minimally invasive procedure, it was decided to opt for a flapless surgery procedure. The implant bed was then Fig. 6_Merged data in planning software (SICAT). The path of nervus alveolaris inferior is marked. Fig. 7_Selection of the virtual implant directly from the implant library of the planning software. Fig. 8_Precise display of soft-tissue contour, safety margin around implant and drill path. Fig. 9_Centralised fabrication of surgical guide by converting radiographic template (right) using CNC technology. Fig. 10_Completed surgical guide. Fig. 11_Detailed view of drilling template: polymerised sleeve for the implantation using the Straumann Guided Surgery Kit. Fig. 8Fig. 7Fig. 6 Fig. 11Fig. 10Fig. 9