Anthony Ponzio In previous posts, I have mentioned how much I love guided implant surgery. It takes a lot of the guess work out of the process, and also reduces the "pucker factor" associated with implant placement. When planned properly, it is generally a very smooth and seamless process, resulting in a good experience for the dentist and the patient. However, despite the fact we have planned everything in advance, we still need to remember to check along the way and make sure nothing has changed or gone wrong, including user error, which is what happened here! I have generally placed Camlog implants due to the ease of their guided system...however, in this case I decided to try Straumann, mainly because of the posts I have seen here and feedback I received from some friends of mine. I stayed away from the system because of the keys required, but I have to admit they were not nearly as big of a deal as I thought they would be.
Patient presented with tooth #4 fractured and unrestorable:
So, I extracted tooth #4 in July 2016 and grafted the site:
The patient opted to wait until last week to come in for implant placement...we planned a Straumann bone level tapered implant 4.1X8 to go right up to the sinus. Here she is prior to surgery:
With the guide in place I began my osteotomy...this is where I screwed up! Being used to Camlog, where you ordered one set of burs, and having this be my first surgery with Straumann, I didn't notice there is a guided bur with 1 line, 2 lines, or 3 lines, correlating to the different lengths:
Even though we are going with a guided surgical protocol, I still always take a check film along the way...thankfully, I grabbed the 1 line drill and not the one with 3 lines! As you can see, I was way short of my desired location(instead of into the sinus if I would have grabbed the other bur), so I had to step back and figure out what happened.
Obviously, this was me being a knucklehead and not an issue with the guide or the system. So, I switched to the 2 line bur that I was supposed to use, and finished my osteotomy, which left me ready for placement at the desired depth:
I placed the implant fully guided-I really liked the way the implant engaged the bone:
And then 1 final PA with the healing cap in place, showing the implant right up to the floor of the sinus where I had planned it:
The patient is aware of the need for a new restoration on #5...
So, keep in mind that although we have planned everything in advance, it is still wise to proceed cautiously and take periodic radiographs to ensure you are following the planned treatment. I have spoken with some dentists who don't take a radiograph until the implant is in if they are placing them guided...this case hopefully shows a good reason to take a check radiograph along the way and make sure you are on the right path, especially if you pull a bonehead move like I did. For the few seconds it takes, it can save you a lot of time and risk later on!
