Single Tooth Restoration Using adinguide™

Dr. Ara Nazarian

Present Situation

A patient presented with a fractured off post/core and crown restoration in hand from the upper right canine tooth (#6).
The adjacent maxillary right lateral (7) as well as the maxillary right central (8) teeth had already been replaced with implant, abutment and crown restorations due to similar circumstances.

All risks, benefits and alternatives were reviewed with the patient.

Clinical Solution

A 3D CBCT scan was acquired in addition to the 2D periapical X-rays. After reviewing the CBCT and radiographs, we decided it would be more accurate and predictable to use guided surgery in this case for redirecting the osteotomy to the most ideal position within the triangle of bone as seen in the cross sectional view of the CBCT. In the past, attempting to freehand an immediate implant osteotomy into an extraction site was difficult because the pilot drill would easily deflect into the path of least resistance.

For this reason, we would perform the surgery using Adin’s fully guided surgical kit to immediately place a dental implant at the appropriate depth and orientation while being accurately indexed to receive a prefabricated CADCAM abutment and fixed provisional restoration. The patient was pleased that we would be able to accomplish everything in a single surgery as compared to her previous dental implants that were accomplished as a two stage surgery. Most importantly, the patient was excited that she would not be toothless or have to wear a removable provisional prosthesis.

After the appropriate planning and fabrication of the surgical guide and abutment, the patient was appointed for the surgical appointment. Once the area was anesthetized, the maxillary right canine tooth was extracted. The surgical guide was positioned and radiograph taken to confirm that it was fully seated. Using Adin’s guided surgical kit, the osteotomy was sequentially prepared using the appropriate drills for a Touareg OS 4.2x16mm dental implant. The Touareg™-S Spiral Implant is a tapered implant with a spiral tap that condenses the bone during placement for immediate stability.

It has two large variable threads and a tapered design for accurate implant placement, self-drilling, improved esthetics and better load distribution. It features a special round shaped apex that pushes the bone graft with minimal harm to anatomic structures. Once the osteotomy was completed, the latch driver and surgical motor was used to insert the dental implant through the guide to approximately 30-40 Ncm until about 3/4 into the prepared site. At that point, the ratchet driver was attached to further torque the dental implant to its final seating at about 50 Ncm.

The CADCAM abutment was tightened and access opening sealed with Teflon tape followed by the fabrication of the provisional restoration. The patient was very pleased especially since we were able to provide a fixed provisional restoration fast, effective and predictably.

About the Author

Dr. Nazarian maintains a private practice in Troy, Michigan, with an emphasis on comprehensive and restorative care. He is a Diplomate in the International Congress of Oral Implantologists (ICOI). His articles have been published in many of today’s popular dental publications and is consistently listed as a top dental educator. He has conducted many lectures and hands-on workshops on aesthetic materials and dental implants throughout the United States, Europe, and Asia.