DentaltownUK October 2017 - 22

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8: Occlusal view of final crown.

Fig. 9: Retracted MIP.

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22

OCTOBER 2017 // dentaltownuk.com

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 was 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 oneweek 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 screwretained, 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.

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. n
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