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The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants Case Study by: August de Oliveira, DDS

So here is a case that sort of goes against some of the stuff I teach. In the posterior I like to have one implant per tooth. I detest any sort of cantilever, be it a pontic or a bulbous crown resulting from an off angle implant. I tolerate cantilevers in the anterior due to the forces of occlusion being lighter. In this case, a patient broke off a cantilever double abutted bridge. Big central sized lateral. So in this case, I decided to do two implants one per tooth and hope to get some interdental papilla growth. Wish me luck! The patient came in without the bridge and we took a CEREC scan with and without the bridge to plan the case.


The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants

Planned for an optiguide using the Implant Direct Guided Surgery Drill Handle Kit. You can see that we just made a little "crown" only on each model and imported the two "yellow stone" models into Galileos and I can toggle between these just like a crown proposal. Two implants in the cingula of both #7 and #8. Make sure you display the guide sleeves to ensure that there is no overlap.

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The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants

Removed the root fragment of #8 with my handy dandy periotomes and confirmed that the guide was seating with the window on the cusp of #6.

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The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants

Used my IME punch and went through the first drills. I still take working length films just like endo. It takes a minute or two and just gives me confidence.

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The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants

Two Legacy3 Implants from Implant Direct. I am using up my stock and will most likely switch to either the Legacy1 or Legacy2 just because I do so many custom abutments. If you are into stock abutments, you may want to look at the Legacy4. The InterActive is a bit of a conundrum for me as I really want to get that deep conical connection and aggressive taper, but won't use the abutment. I'll still most likely switch to that one just for the implant body.

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The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants

Any long term immediate temp in my office gets a Bio Temp or a CEREC Temp. In this case, I just used the stock Legacy3 abutments and took a PVS impression for a Biotemp. Could I have scanned in CEREC? Yes, but I would have had to sand blast the abutments and was in a bit of a rush.

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The King of Wishful Thinking: Optiguide Anterior Case with Legacy3 Implants

Bio Temps. Let’s see how the papillae grow. We know we want the platform of the implants to be no greater than 5mm from the base of the contacts. In this patient, she really did not have any papillae before so I will most likely just keep the contacts low and close up the dark triangles with porcelain. Way out of occlusion and excursives. Will wait 4 months and post the finals.

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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The King Of Wishful Thinking Optiguide Anterior Case With Legacy3 Implants  

The King Of Wishful Thinking Optiguide Anterior Case With Legacy3 Implants Case Study by: August de Oliveira, DDS

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