Jeremy Bewley Now that I've got your attention, let me give you some context: I had a resident come through to observe a few months ago, and on seeing the clinical presentation of the proposed site, she felt that there was no need for a guide or even CBCT, and that she could close her eyes and treat this patient.
Having followed what is now standard protocol in my practice, I took advantage of the integration of CEREC and the SL, merging the files and creating a prosthetically driven treatment plan. You will note the potential for problems in this surgery due to the very large incisive canal in close proximity to the planned fixture position, hence the surgical guide.
I printed my surgical guide with the Formlabs printer and performed my osteotomy; I have come to expect these guides to be very consistently accurate.
I planned on enucleating the nerve and grafting at time of implant placement, as it was clear from planning that there was inadequate bone on the palatal side for this fixture.
I saw him for his 4 month follow up last week and his healing looks acceptable enough that I am releasing him to his restoring dentist.
I was thinking about this case and the comments of the resident, and I imagined attempting the case without the benefit of three dimensional prosthetically driven planning. I was thinking about how hard it would be to keep my osteotomy true without the benefit of the guide; it would be so easy to end up either too far buccal, or perhaps perforate the palatal and end up in the incisive canal space. I went back and looked at this view again...:
...and it reminded me of why I made the commitment to add this technology to my practice: it increases the quality and consistency of care I can provide for my patients. In hindsight, working without these tools and their protocols is very much like doing it blindfolded, and it is not fun.
Jeremy
