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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide Case Study by: August de Oliveira, DDS

We are all friends, you know me, I am the "Implants Made Easy" guy, right? Well for some reason it’s been "Implants Made Especially Hard" in my office lately! Immediate cases, edentulous cases, CEREC Guide up the Ying Yang. Everyone wants an immediate temp and wants it yesterday! And this falls into my lap! Too busy to treat, I took an alginate, a Galielos scan and sent the patient on her merry way! Ah, the luxury! Immediate implant #29, plenty of bone, nerve fairly far away. She wants a tooth ASAP, which I'm cool with.


Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

One, very minor complication is her anterior loop of the mental foramen! Look at that bad boy! Extends past the canine. No worries, she still has a ton of bone!

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Got the guide back from Germany in 6 days. Used my handy dandy extraction tools. We will have these up on the site http://www.implantsmadeeasy.com, but give me some time. Just got the first shipment of my CEREC Guide handles which I need to get to those that pre-paid. And then about 50 pre-orders but once I get that down, I'll put my stuff up. And, of course, they are all colored blue to match my eyes ;} Atraumatic extraction of #29 with my periosteal and periotomes.

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Very smooth sailing. As always, place your pilot in the ostoetomy to measure the true depth and lean back to assess the angulation, check out the anterior loop in the PA!

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Legacy3 3.7mmD by 16mmL! Awesome stability! Maybe a little close to the nerve for my comfort, but we are lingual so there is more bone there. Indexed to the lingual.

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Right after placement, placed a scan post and imaged with the CEREC. Note my placement and the resultant screw hole! Designed using a TSV 3.5mm scan post in CEREC 4.2.

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Tried in again, note the screw hole position. Did not pay attention to the occlusion in the CEREC software and paid for it with a lot of grinding! Carved the anatomy back.

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

So can I digress a bit? Check out the screw hole in the Galielos plan, the CEREC plan, and the final! I mean come on, how can that be more accurate? Planned, placed and final. There has been a lot of bad press from the old guard and just jealous types that say Guided is nonsense, but come on! To those naysayers, this image happily proves you wrong!

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

As always, I like to progressively torque my abutment screws, using the Implant Direct Legacy3 screw not the Ti Base screw. I start at 20, wait a bit, then 25, and another bit, and then 30. Great stability even with an immediate!

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Another interesting phenomenon with the Emax block, the translucency!! With screw retained PFMs I have the problem of always being too translucent with my composite in the access. In this case, I am too opaque with my composite! Who knew? Flow it ALC opaquer and .4 opaque A3 with a sponge in the access!

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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

Final!! It’s just killing me that I have some flash in my photo!! I want to get the patient back and retake the final. But again, you can see my ochre stain and access and if anything I could have done without the opaquer! If you are not doing Emax abutments and Screw retained crowns, you are missing out! This stuff is unreal!

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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Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide  

Kitten Whispers and Tickle Fights: Easy Guided Immediate with Legacy3/Emax Abutment and Optiguide

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