DentaltownUK July 2018 - 17

show your work

Fig. 11

Fig. 12

In this case it was elected to place three
implants which would support two separate
bridges.
On the right, there was to be a double
abutting three-unit bridge restoring #11-13
with two implants in the 13 and 12 positions.
On the left there was to be a two-unit
cantilever bridge restoring 21 and 22 which
was supported by single implant in the 22
position.
Once I had globally selected the sites
for the implants, the decision was made on
how best to position and angle the implants
so that we could obtain screw retention.
Once a digital wax-up has been done with
the tooth positions set, these teeth can be
superimposed onto the CBCT scan and then
the implants virtually placed in their ideal
positions to provide retention (Fig. 2, p. 15).
This process will be explained in far
greater detail in Part 2 of this article.
Once the implant position has been designed
upon them, the implant guide can be made
which when secured to the teeth will ensure
that the operator will drill the osteotomy in
exactly the correct place.
The drill guide helps to control the angle of
the drill in terms of buccolingual angulation,
mesiodistal angulation and also the depth of

the osteotomy and hence determine the final
implant position.
Figures 3 and 4 (p. 15) and Figures 5 and
6 show the patient before surgery but after
initial extractions and periodontal therapy.
After anaesthetising the patient, I tried
in the drill guide (Fig. 7) and pushed a bur
through the guide hole (Fig. 8) to mark the
mucosa (Fig. 9). This helps to position the
primary incision (Fig. 10) because if able to
join those dots, then a flap can be raised in
the position that helps to see the maximum
amount of ridge. The site of the proposed
osteotomy will be right in the middle of
where that flap has been raised.
I've also found that if I introduce local
anaesthetic (under high pressure) directly
onto the ridge, I find it much easier and
quicker to raise the flap, because the liquid
helps to separate the periosteum from the
bone (Fig. 11).
The guide was placed and the implant
pilot drill was used through the guide holes,
allowing the guide to control where the bone
was drilled (Fig. 12).
Three osteotomy pilot holes were prepared
(Fig. 13). This initial step used to take me a
long time because I would be agonising over
the correct position to start the osteotomies.

Fig. 13

Fig. 14

Fig. 15

Fig. 16

dentaltownuk.com \\ SUMMER 2018

17



http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK July 2018

Mike Gow: A Consultation with...Alasdair Gillies
Howard Speaks
Continuing Education Update
My First Clear Aligner Case
Show Your Work: Guided Implant Surgery (Part 1)
Message Boards: How Long Is your Hygiene Appointment and What Does She Do?
Cover: Wellcome Collection Exhibition
It's All in the Chemistry
Time Out
Dental Aid Network
Message Boards: It's What You Say and How You Say It
Advertorial Tipton Training
BACD News
DentaltownUK News
Students
Quiz
DentaltownUK July 2018 - Cover1
DentaltownUK July 2018 - Cover2
DentaltownUK July 2018 - 3
DentaltownUK July 2018 - 4
DentaltownUK July 2018 - Mike Gow: A Consultation with...Alasdair Gillies
DentaltownUK July 2018 - 6
DentaltownUK July 2018 - 7
DentaltownUK July 2018 - Howard Speaks
DentaltownUK July 2018 - 9
DentaltownUK July 2018 - Continuing Education Update
DentaltownUK July 2018 - 11
DentaltownUK July 2018 - 12
DentaltownUK July 2018 - My First Clear Aligner Case
DentaltownUK July 2018 - 14
DentaltownUK July 2018 - Show Your Work: Guided Implant Surgery (Part 1)
DentaltownUK July 2018 - 16
DentaltownUK July 2018 - 17
DentaltownUK July 2018 - 18
DentaltownUK July 2018 - Message Boards: How Long Is your Hygiene Appointment and What Does She Do?
DentaltownUK July 2018 - 20
DentaltownUK July 2018 - 21
DentaltownUK July 2018 - Cover: Wellcome Collection Exhibition
DentaltownUK July 2018 - 23
DentaltownUK July 2018 - 24
DentaltownUK July 2018 - 25
DentaltownUK July 2018 - 26
DentaltownUK July 2018 - 27
DentaltownUK July 2018 - 28
DentaltownUK July 2018 - It's All in the Chemistry
DentaltownUK July 2018 - Time Out
DentaltownUK July 2018 - 31
DentaltownUK July 2018 - Dental Aid Network
DentaltownUK July 2018 - 33
DentaltownUK July 2018 - 34
DentaltownUK July 2018 - 35
DentaltownUK July 2018 - 36
DentaltownUK July 2018 - 37
DentaltownUK July 2018 - 38
DentaltownUK July 2018 - 39
DentaltownUK July 2018 - Message Boards: It's What You Say and How You Say It
DentaltownUK July 2018 - 41
DentaltownUK July 2018 - 42
DentaltownUK July 2018 - 43
DentaltownUK July 2018 - 44
DentaltownUK July 2018 - 45
DentaltownUK July 2018 - Advertorial Tipton Training
DentaltownUK July 2018 - 47
DentaltownUK July 2018 - BACD News
DentaltownUK July 2018 - 49
DentaltownUK July 2018 - 50
DentaltownUK July 2018 - DentaltownUK News
DentaltownUK July 2018 - 52
DentaltownUK July 2018 - 53
DentaltownUK July 2018 - Students
DentaltownUK July 2018 - 55
DentaltownUK July 2018 - 56
DentaltownUK July 2018 - Quiz
DentaltownUK July 2018 - Cover4
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