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Fire in the Hole: Completed Case with CustomDirect Titanium Abutment Case Study by: August de Oliveira, DDS

Here is a case where I combined a lot of technology! I'm in my 40s and while guys my age are getting combovers and corvettes, I'm out accumulating technological gadgets! I just got a new DEKA Smart CO2 Laser and this thing rocks! It actually cuts like a scalpel! In this case, we treatment planned for a Summers lift of the Sinus on #14. We had also planned for #29 and #30 implants, with #30 being an immediate but we had to punt and graft the socket as I had to remove too much bone. So I will post that case after she heals and we get back in there. Ordered two guides and two separate orders but one scan.


Fire in the Hole: Completed Case with CustomDirect Titanium Abutment

Although I am sure I have to practice more, the punch was really easy. I was surprised at how quick the tissue came out. Again, one really cool benefit of this CO2 Laser is that it feels more "scalpel" like. When you move about the tissue you can see the cut. And of course you get that great heme control, because you all know how I hate the sight of blood!

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Fire in the Hole: Completed Case with CustomDirect Titanium Abutment

Sinus expanders used after the 2.3. Start with the ones with a sharp apex then move to the dull ones. I use a ball ended probe to check, in this case we are really in hard up-fractured bone so I did not feel the need to graft. I have bone surrounding my osteotomy.

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Fire in the Hole: Completed Case with CustomDirect Titanium Abutment

Implant placed, tough to see but we have a "mound" of sinus membrane punched up past our implant. One thing that I don't like about Sinus Expanders is that if you can’t use them in the guide they walk. I could not really see the expander in my guide as I set the D2 high to get up to the sinus floor so I used them free hand. In my plan, the apex was where I wanted it to maximize bone, but my platform was closer to #13. In this case, I am more upright, not tough to restore, but not perfect either.

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Fire in the Hole: Completed Case with CustomDirect Titanium Abutment

Took off the standard cylindrical healing abutment and replaced with a contour healer. Due to the rotation of #12 I could not get it in the way I wanted it. In retrospect, I should have just cut the healer on the meal as the end result was not as much tissue contouring as I would like.

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Fire in the Hole: Completed Case with CustomDirect Titanium Abutment

I'm just not feeling the final crown. Again, hindsight is 20/20 but you can see that #19 is buccal and supra erupted. I should have cut #19 down a bit to allow my crown to have better overlap and overjet. But I just love all sorts of custom abutments and this one was made by Implant Direct in their CustomDirect department, which will soon be offering Zirconia!

Dr August de Oliveira graduated from dental school in 1997 from the University of Washington and completed his General Practice Residency in Los Angeles in 1998. Dr de Oliveira has been lecturing on 3D technology since 2004, when he started as a CEREC Basic trainer. Since 2008 he has been involved with Implant Direct’s R and D department developing Guided Surgery Software and Hardware and testing their CAD Milled Bars and Substructure Department. Dr de Oliveira has written two books on Implantology: Implants Made Easy and Guided Implantology Made Easy. He has been involved with beta testing Sirona’s Sidexis Program, as well as developing the Opti and CEREC Milled Surgical Guides. Dr de Oliveira lectures nationwide for Sirona on the Galileos Cone Beam system and Sirona Guided Implant Surgery. He also teaches for Implant Direct at their Las Vegas Educational Facility and with the Engel Institute in Charlotte NC. Dr de Oliveira lives and practices in Los Angeles CA.

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Fire In The Hole Completed Case With Customdirect Titanium Abutment  

Fire in the Hole: Completed Case with CustomDirect Titanium Abutment Case Study by: August de Oliveira, DDS

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