Original Source – Engel Institute

As previously described, non-restorable teeth were removed and grafted.  Following integration of the graft, 4 Straumann BLT implants were strategically placed using the Engel protocol. The implants were allowed to integrate for an additional 2 1/2 months, after which the healing abutments were removed and a final impression made for a screw retained mandibular bridge.

Healing abutments are placed to train the soft tissue. Once removed you can evaluate the gingival cuffs created.

Straumann impression copings are placed and the final impression is made using Kettenbach medium body wash material and a putty tray material.

The accurate impression is used to fabricate a soft tissue model onto which the screw retained implant bridge was fabricated.
 

Because the implants were placed to allow for the access screw holes to be in non esthetic areas, the bridge is torqued to position. Composite resin is used to cover over the access screw holes.
 

Our patient is thrilled with the final esthetic and functional result using the Straumann BLT implant system.
 

The post Prosthetic Design and Fabrication of a Straumann Implant Retained Mandibular Bridge appeared first on GreenCT.

Here is a periapical radiograph taken on the same day… diagnostic..?? Perhaps only after you know what’s there. And you can only know with CBCT….

The post Periapical Radiograph Not Diagnostic – Power of CBCT appeared first on GreenCT.

PANO and CT Images taken on PaX-i 3D Green and
Periapical image was taken with the Vatech EzP Sensor.

INTRODUCTION:

• 52 year old male
• Presented with chief complaint of a pimple in the maxillary right quadrant.
• After an oral evaluation we took a panoramic image as a overview.
• During the patient interview and history, the patient expressed a strong desire to try to save the teeth in that area at all cost.

PATHOLOGY:

Looking at a magnified view, on the panoramic film, my initial diagnostic feelings were that the distal root of tooth #3 was creating the draining sinus tract.

Following the ALARA Principle I chose to take a periapical radiograph for additional information and to get a clearer image of the area so as to confirm my diagnosis.

The periapical radiograph seemed to confirm my original diagnosis but showed that the area of the periapical pathology extended over to the mesial buccal root of tooth #2. (Progressing) At this point I had concerns regarding the most predictable course of treatment for my patient.  I chose, with patient consent to take a cone beam ct image of the area.

3D RADIOGRAPHS:

• Magnified view of the sinus perforation

• The cone beam image clearly shows that the periapical pathology is associated with the mesial buccal root of tooth #2. 

• a coronal view of the mesial buccal root of tooth #2 shows a communication with the maxillary sinus and consequent pathology in the sinus.

• This volume rendering shows the loss of the buccal plate of bone on the mesial buccal root of tooth #2.

CONCLUSION:

The panoramic image and the cone beam images were taken by our PaX-i3D Green.  The periapical image was taken with the Vatech EzP Sensor. Most importantly, this case shows how through the utilization of cone beam imaging we were able to make a definitive diagnosis and ultimately create a treatment plan with a more predictable outcome.

The post Sinus Pathology Imaging appeared first on GreenCT.

Original Source: CNY Implant Journal Issue No. 2 September 1, 2013

The post The Management of Impacted Maxillary Canines with CBCT Technology appeared first on GreenCT.

Pre and Post Surgical Script

:00 – Starting from the MPR window we can see the two eventual sites for teeth number 7 and number 10 in the 3D reconstruction window in the bottom right-hand corner.

:13 – Left click on the 3D pan icon tab along the top of the window where we can see our pan reconstruction at the top our Scout or axia view iin the bottom left as well as a sectional views in the bottom right-hand corner.

:20 – From here to left click on a navigation Pane and move it to site number 7 or we can also then England match the angle of an implant or in this case here parallel to are adjacent teeth numbers 6 and number 8.

:30 – I cannot navigate to the toolbar at the top and left click on the ruler and then measure from facial too powerful and then measure from the ridge up to the anomaly.

:45 – We then move the navigation pane over to site number 10 and and then left click to rotate the lines to match the angle of an implant or parallel to teeth numbers 9 and 11.

:60 – click on the ruler again and then measure in the sectional window  the bottom from the facial to palatal and then from the ridge to the sinus floor.

1:10 – there is a shortcut feature whereby you can right-click on the vertical Dimension and then choose to place an implant if you’re not seeing the size implant in the shortcut list and also then left click on the insert implant icon in the upper left-hand corner of the software.

1:20 – from the implant property window we can first use or tooth number and then from there to the size along  the right-hand side and put a check mark to place a crown and then left click on insert.

1:30 – once you place the implant you can reposition it in the second abused the bottom as well as rotate the implant around in the 3D pen reconstruction window at the top.

2:00 – we can then move our navigation pane over to site number 7 again. Select the insert implant icon along left hand side to the to open the implant property window  , then scroll down to choose your implant size and then put a check-mark there for Crown as well and then select insert.   Drop the implant in place and the sectional window in the bottom right-hand corner. Reposition in both the sectional window and 3D pen window as needed.

2:55 – post surgical placement assessment.

3:00 – we can then assess the placement of an implant in mpr window by adjusting or sagittal coronal and axial line as needed to verify placement between the two cortical plates as well as placement between existing teeth.

3:20 – now select a 3D pan tab  on the top of the window and then assess the placement of our implants in the sectional windows in the bottom right-hand corner.

3:30 – slide the navigation pane over the implant site number 7 and adjust the angle to match the angle or implant and then use the sectional views to verify the angulation of the implant between the two cortical plates.

3:50 – Slide the navigation pane over to site number 10 to evaluate placement of the implant. Rotate the navigation pane to match the angle  of the implant and then use the sectional views to verify the angulation between the two cortical plates as well

Radiology Report

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Clinical Photos

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Ez3D Plus Treatment Planning

Narration: Lennart Elgaard, Education Manager, Vatech America, inc.

Timestamp Script:

0 – 0:18 – Introduction to the Ez3D software to identify the placement of our virtual Hahn implants in site number is 7 as well as site number 10.

0:18 – 0:37 – At this point we’re going to be working in a maxillary arch, so we’re going to construct our 2D pan curve by moving our axial line to the ridge in a coronal view and then in the sagittal you were going to compensate for the angle of our occlusal plane by moving the axial, so that it is parallel to the ridge or to the occlusal plane.

0:37 – 1:01 – We’ll then construct our 2D pan reconstruction which will also generate our sectional views by left clicking the icon for a panorama curve and then we’ll start in the axial window with the distal edge of the right molar and digitize our landmarks approximately 1 centimeter apart and in between the two cortical plates until we get to the distal edge of the molar on the left hand side of the anatomical arch.

1:01 – 1:24 – We have our 2D pan reconstruction in the bottom left hand pane, the sectional views show us our bone width as well as our bone height. The axial view will identify the location of each sectional view.

1:24 – 1:57 – We can measure our occlusal spacing between number 6 and 8 as well as between 9 and 11 if you wish to verify the amount of space that we have available for our two virtual implants. We can start by expanding our to 2D pan reconstruction. From there we can navigate to the measurement icon in the upper left hand corner left again and then measure the distance from the mesial edge of tooth number 6 to the distal edge of tooth number 8. This measurement gives us a distance of approximately 7 millimeters.

We can then measure the occlusal spacing for site number 10 by measuring from the distal edge of number 9 to the mesial edge of tooth number 11. This also gives us a distance of approximately 7 millimeters again.

1:58 – 2:30 – We can also measure our occlusal spacing by using our sectional views as well. Knowing that our intervals are one millimeter apart we can essentially use the section sectional views as ruler to measure from the mesial edge of number 6 to the distal edge of tooth number 8. To do this we move our sectional line in the 2D pan reconstruction to the mesial edge of number 6 and then using our sectional numbers in the upper right hand corner, we can simply count how many sectional panes there are between the edge of number 6 to the edge of number 8. The edge of tooth number 6 was number 49 and the edge of tooth number 8 is sectional number 56 which gives us a 7 millimeter distance occlusal spacing, the same as shown in the 2D pan reconstruction.

2:30 – 2:57 – We can do the same thing for site number 10 if we take the sectional line to the edge of tooth number 9 which is section on number 71 and then by counting each sectional view until we get to the edge of tooth number 11 which is section number 78 , giving us a 7 millimeter occlusal space.

2:57 – In order to place our Hahn virtual implants, we’ll start again with site number 7 by moving our sectional line equidistant between teeth numbers 6 and 8. We can and measure our bone width as well as our bone height. We select the 2D measurement tool and from there measure from facial the palatal to get a bone width and then measure again from the ridge to get bone height.

3:35 – 4:08 – We can then go over to site number 10 and do the same thing. We’ll pick a location equidistant between teeth numbers 9 and 11 and it’s like a ruler to measure again from facial to palatal to get our bone width. We can select the measurement tool again to measure from the ridge to get our bone height.

4:08 – 4:45 – Now that we have suitable bone width verification of bone height, we can then go back over to site number 7 to place our Hahn virtual implant. We will left click on implant library left click on our implant system, Glidewell Hahn and then pick the implant from the product line down below. Left click in the sectional view to place the implant and then use the blue axis lines to rotate and orient the implant appropriately between the two cortical plates.

4:45 -5:06 – Now let’s go over to site number 10 as well to place our virtual implant there. We can right click to remove the dimensions. We can then navigate to the implant library again and choose our Hahn virtual implant.  Select insert and then left click to place the implant and then rotate to a line between the two cortical place again.

5:06 – 5:20 – We can also orient the implant in the 2D pan reconstruction to align it so that it is in parallel to our adjacent teeth.

5:20 – 5:25 – Once we have regulations set in both the sectional in the 2D pan reconstruction window, we are ready to complete our treatment plan

5:25 – 5:40 – If you want to verify that we have suitable bone to place our implants, we can simply right click on the implant and then select ‘show bone density.’ We can see that we have suitable bone in site number 10 as well as in site number 7.

5:40 – 6:15 – You can also add an abutment onto our virtual implant as well, by right clicking on the implant again and then selecting property. We can verify the implant system that we chosen and then select an abutment and then choose the style, length, width, etc., and then select OK. And then do the same thing for site number 7 by right clicking, selecting property, and then selecting an abutment.

6:15 – Now that we’ve completed our treatment plan, we are now ready to save it and then schedule our surgery.

The post Implant Planning Using Ez3D-i and Ez3D Plus – #7 and #10 appeared first on GreenCT.

When the Straumann dental implants are carefully planned and positioned, the final implant retained crowns are expected to have an excellent prognosis and provide our patients years of function and esthetics.

Post-operative radiographs of the Straumann implants ideally placed in the maxillary left quadrant and mandibular right and left quadrants.  Length, width and angulation of the implants are determined using the Engel protocol learned in Mentoring 1.  The days of improperly placed implants with prosthetic compromises are now gone.

Because we were able to torque all of the implants to over 25Ncm, taller healing abutments were placed, eliminating the need for anesthesia to uncover the implants prior to final impressions.

Healthy tissue cuffs are achieved due to the use of the healing abutments.

The dental lab fabricated custom titanium abutments. Note how the margins are at or just slightly subgingival eliminating any chance of getting cement subgingivally, maintaining periodontal health and contour. Seating guides are helpful during the torquing of the abutment screws to 35Ncm.

The final abutments in position.  I will normally place a small piece of cotton into the access openings and cover with Cavit.

The complete seating of the abutments are always checked with a digital radiograph.
 

The final Bruxzir crowns are cemented into place using IMPROV transitional implant cement.
 
 

The final crown seating is checked with a final radiograph. Notice the platform switching design of the final abutments and implant retained crowns.
 

The post Efficiently & Predictably Restore with the Engel Implant Surgical Placement Protocol appeared first on GreenCT.

I bet you do!

Original Source – Engel Institute

Pre-operative CBCT analysis demonstrates adequate bone height.  Being aware of vital anatomy is critical to reduce your anxiety in considering placement of a dental implant in the posterior mandible. Being able to atraumatically extract and diagnose for a single posterior dental implant is an important part of our general dentistry practices.

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Pre-operative digital radiograph of a non-restorable primary tooth indicates the need for extraction. The tooth was removed and the site allowed to heal for a few months, per the patient’s request. The Engel protocol is followed and a two-dimensional radiograph helps in the evaluation of available vertical bone.
  

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The Straumann surgical burs help create proper medial-distal and facial-lingual angulation of the implant, to help ideally place the implant.  Dr. Engel promotes visualizing the final crown BEFORE considering a dental implant.  Therefore, proper implant placement will allow for more predictable restorative results.
  

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The implant was torqued to 35Ncm, so a taller healing abutment is placed, eliminating the need for further anesthesia upon taking the final impression. The Straumann impression technique is used. Our dental laboratory provides a screw retained implant crown to replace the missing first molar.
  

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The final implant crown is torqued to 35 Ncm and our patient is thrilled with the final functional and esthetic result.
  

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