Love this Community...and this Workflow
A few years ago I was doing ZERO surgery in my office. No extractions, no implant placements, nada.
This community has a way of encouraging and pushing each other to cause some serious growth. I was encouraged by multiple CDocs to take Gargs Continuum and start doing more surgery in my practice.
Had a great time going through the continuum with my fellow CDoc Gate$. We went to the DR together and placed a ton of implants.
That encouragement from other CDocs has allowed cases like the one below to become common place in my practice, where 3 years ago I wasn’t even extracting teeth. I know this is quite boring compared to some of the full mouth rehabs we see, but this is the everyday dentistry that walks into my practice.
This pt presented to my office with a “sore tooth”.
Extraction was completed along with graft of FDBA with PRF. After healing, the pt returned for CEREC scan and CBCT with Orthophos SL.
“Digital waxup” using the chairside software.
Integration with DICOM data from Orthophos SL. This process is too easy.
Digitally planning the placement of the implant with the restoration in mind makes restoring these as screw retained a breeze. It also saves me a lot of stomach lining the day of surgery.
By using the position of the “digital waxup” of #30 I was able to make sure the implant was planned with lingual inclination to allow for ideal position of the screw access hole.
Placement.
Scan after integration.
The planned placement makes the proposal in the software need almost no tweeking whatsoever.
Delivered.
Again, I know this is just a single unit restoration. There are way more exciting cases out there on the boards. But, I want to give a big thanks to this community, the discussion boards, and the online continuum for the incredible resources that they all are.
Critiques welcomed 
Snider,
Amazing work!! I second everything you said. I never in a million years thought I would be placing implants in my office, now I am thanks to CDOCs.
PS.....I won't tell Mark you didn't scan to the midline. 
Thanks for sharing.....
See what I did there. LOL
Tom
My only critique. You scanned after the integration. Scan at the time of placement. Other than that rockstar! :)
That's awesome Michael !
Now, by posting this great example of what you can now do, you are encouraging others to follow in your footsteps - "paying it forward". THIS IS what C'Docs is all about and why we love belonging to this community as you so eloquently stated.
Winnie
I will be pulling the trigger on the Orthophos shortly because of posts like this...Sirona must sure love CDOCS! ;)
Thanks to all you dirty SOBs...Im flying to LA tomorrow for my first implant weekend with the new Atstra EV kit. Same as you MS, I wouldnt have done it without the push from the Cdocs mentors. We do all the hard stuff with planning and printing guides, it only makes sense to put the damn things in!
Nicely done baby bird. It may be some time to go back to the DR soon for some humanitarian work
And there really is nothing like this community. It continually allows me to push my practice. I learns a long time to hang out with people that you want to learn from and become like. There are so many incredible selfless people in the community making others better every day in here. Love this place!
On 4/19/2018 at 2:38 pm, Richard Rosenblatt said... And there really is nothing like this community. It continually allows me to push my practice. I learns a long time to hang out with people that you want to learn from and become like. There are so many incredible selfless people in the community making others better every day in here. Love this place!
Whatcha doin tonight Rich? 
I will second exactly what rich said. This community is amazing. I have met many great people here that took me in. I have the exact same philosophy. Hang out with others that will bring you up and make you better. I am very grateful for the friendships I’ve made through here and for it making me a better dentist.
On 4/19/2018 at 2:47 pm, Jeffrey Gregson said... I will second exactly what rich said. This community is amazing. I have met many great people here that took me in. I have the exact same philosophy. Hang out with others that will bring you up and make you better. I am very grateful for the friendships I’ve made through here and for it making me a better dentist.
Im going to make this very simple- if you want to go online and tell everyone how great you are and how the treatment that someone else posted sucks and you do it better and blah blah blah, go somewhere else.
cerecdoctors.com is not for you.
On that note- Snider- your implant placement looks off. I can do it better and your crown is going to fail prematurely. and your watch sucks!
On 4/19/2018 at 3:19 pm, Michael Snider said...Sam, think Meena knows what time it is in Boston?
He knows the time- its just not the right time.
On 4/19/2018 at 4:07 pm, Robert Lang said...Nice case, great community, I agree with Sam, scan when its placed, you will love it.
I usually wait until the implant has integrated before I scan as I am concerned the neighboring teeth may shift in the couple months wait resulting in interproximal contacts being too tight or OPEN! Should I not be concerned about this? Seems like for the screw retained crown implants the interproximals have to be right on(assuming the implant is positioned exactly where it should be...surgically guided). They drop right in place with the Cerec integration. Anyone else seen this happen by scanning at placement?
All this watch talk...Sam, do I need to remind you about Mickey Mouse?
Awesome Baby Bird...I have yet to meet someone who got involved with this group that hasn’t improved their practice and their enjoyment of dentistry. I am thankful for this group on a regular basis...time to go back to the DR!
Michael,
Did you use any type of membrane for the socket grafting, how long did you wait, and how was the bone graft when you placed the implant?
Whenever I see a bone graft that is not continuous with the host bone (seam between the bone graft and the host bone such as in the cross sections above) the bone graft is usually not truly integrated (based on some of my own cases).
Farhad
On 4/19/2018 at 6:02 pm, Richard Powell said...On 4/19/2018 at 4:07 pm, Robert Lang said...Nice case, great community, I agree with Sam, scan when its placed, you will love it.
I usually wait until the implant has integrated before I scan as I am concerned the neighboring teeth may shift in the couple months wait resulting in interproximal contacts being too tight or OPEN! Should I not be concerned about this? Seems like for the screw retained crown implants the interproximals have to be right on(assuming the implant is positioned exactly where it should be...surgically guided). They drop right in place with the Cerec integration. Anyone else seen this happen by scanning at placement?
If the distal tooth has stable perio the drifting you are worried about usually does not happen. That being said what I do is scan at time of placement and a week or so before uncovery I have the Pt come into the office for a tissue check. At that time I scan the soft tissue in gingiva mask folder. I can use this to check to see if any drifting has occured, I can also adjust contacts at this time if needed. I can used this folder to dial in contacts if needed
Uncovery is now delivery in a very efficient and predictable manner
Farhad,
At the time of the graft, I made "sticky bone" and used a Straumann Flex membrane.
We waited almost 6 months before placement of the implant and the graft seemed stable. I flapped this case to check the placement because it was one of the first cases where I used the Form2 to print the .stl from SiCat. The implant had good torque at placement via the iChiropro motor.
Do you think I would have seen less of a seam between the host bone and graft if I would have waited longer? Or is this just something I will see on some cases?
Still learning and appreciate the comments!
You said it well and I couldn't agree more... the support and enthusiasm to continually raise the bar of the service that we offer to our patients by CDocs members is fantastic. Personally, I know that it has given me the encouragement to venture outside my 30+ year comfort zone of care but has also made me a better dentist.
Michael, I can relate to your journey. Because of this group I now place implants, am taking spear workshops, Cerec workshops, etc. Its helped me be excited about dentistry again.
As I am in Richmond VA today for my 10 year dental school reunion at MCV I realize how CEREC Doctors with this community has been instrumental in my growth as a dentist! I would not be placing implants without taking the ridiculously amazing journey with you Snider! The relationships and bonds that are formed within this community are unexplainable and ever evolving! BEST COMMUNITY IN DENTISTRY!
Awesome case Michael! Really appreciate CEREC and Cdocs for relighting the fire for my dentistry. I love the technology and am bummed on days I don't have something going on with CEREC. I appreciate you and Tom Monahan sharing your knowledge (along with all the other Cdocs in this group) in getting me started and learning every day. Still blown away by what you all do. Starting Dr. Garg's course in the Summer!
On 4/19/2018 at 8:25 pm, Farhad Boltchi said...Michael,
Did you use any type of membrane for the socket grafting, how long did you wait, and how was the bone graft when you placed the implant?
Whenever I see a bone graft that is not continuous with the host bone (seam between the bone graft and the host bone such as in the cross sections above) the bone graft is usually not truly integrated (based on some of my own cases).
Farhad
Farhad, in your experience, does that mean that that bone will never be integrated or is just a slower process of? If you saw that on your patient would you remove and replace it?
I'm just asking for a friend...
Michael and Aaron,
As a general rule the longer you wait for bone grafts to heal the better. I always laugh when folks say they re-enter a socket graft after 3 months. I would always wait 1 year or more if I could but that's not practical so I typically re-enter at 5-6 months depending om the size of the defect.
In this case if the bone was solid at re-entry then all is good and the seam may just be less dense bone. However, in my experience if you see a seam like that then the bone graft is mostly soft/mush and will never really integrate. Remember that the healing of the bone graft occurs from the host bone so if there is a discontinuity there then that's not a good sign.
Couple of tips: In a big defect such as this one make sure the defect is thoroughly debrided and completely void of any residual soft granulation tissue, use a non-resorbable PTFE membrane instead of a resorbable membrane (resorbable membranes are not that predictable in my experience), and when you place the implant then place a 2mm healing cap instead of a cover screw (makes your life easier at uncovering).
Farhad
P.S.: Is Gate$ really spelled with a $ sign? Of course it is.
