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PEEK performance: In this case, Dr. Léon Pariente used a PEEK Healing Abutment to shape the soft tissue. The lateral view after crown placement shows proper support of the soft tissue.
the implant and the wall of the abutment mal or buccolingual food traps and allows Because of the popularity of standard
should be as wide as possible to avoid creat- the patient to maintain the required level of abutments that are cheap and easy to use,
ing a bacteria reservoir. hygiene around the implant. Furthermore, people often think that
In addition, the connection type (exter- it is a prerequisite for the formation of it is very complicated
nal or internal) and the collar of the implant, pseudo-papillae in the interproximal spaces. or expensive to
whether polished or not, have a direct influ- Poor emergence profile design can have con- create
ence on the depth to which an implant can sequences that can ultimately lead to the
be placed to protect the surrounding bone loss of the implant.
from physiological resorption while retain-
ing the biological width. Internal connec- What are the main challenges in establish-
tions such as Nobel Biocare’s conical con- ing an optimal emergence profile?
by Dr. Gary Orentlicher, US ough analysis of bone volume and structure 8 significant alteration of bony anat-
and of tooth and implant orientation. This omy (e.g., trauma, grafting, distrac-
n I have frequently remarked that in the last means more precise evaluations, minimally tion and pathology)
15 years there has not been a greater prac- invasive procedures, more predictable treat- 8 medical problems (e.g., radiation
tice builder for me, as an oral and maxillofa- ment results, shorter appointment times and therapy, bleeding dyscrasias, and
cial surgeon, than my involvement in guided happier patients. orthopedic and psychological prob-
surgery. Using my i-CAT (Imaging Sciences lems).
International), in combination with Nobel- In a presentation I made this spring,
Clinician Software (Nobel Biocare), has made I spoke about what I regard as the indica- In each case, there are four primary
me a better, more accurate dental implant tions for guided surgery. They include steps to a successful guided surgery
surgeon, and most importantly, has greatly workflow:
improved my patients’ case outcomes. It 8 three or more implants in sequence
has changed the way I practice daily in all 8 cases with anatomical and/or structural 8 Step 1: 3-D imaging with a scanning
aspects of patient diagnosis, planning and issues prosthesis or optical scans
surgery. 8 implant position critical to a planned res- 8 Step 2: 3-D treatment planning with
toration planning software
i-CAT and NobelClinician allow for treat- 8 problems related to proximity of adjacent 8 Step 3: Creation of a computer-
ment planning and surgical predictability teeth generated guide, laboratory and sur-
with full 3-D and restorative outcomes in 8 fully edentulous patient cases gery Dr. Gary Orentlicher
mind. i-CAT’s high-resolution volumetric im- 8 immediate extraction and implant place- 8 Step 4: Knowledge of the appropriate
ages provide complete views for a more thor- ment implant-specific drilling instrumentation.
I have my CBCT scans converted into
In my clinical ex- DICOM data sets and imported into Nobel-
perience, the quality Clinician for treatment planning. I have used
of the products one most implant software on the market and
uses makes a signifi- I feel strongly that NobelClinician is the pre-
cant difference in mier product.
the process and final
treatment result. I For clinicians with an interest in using
look for quality, ease the power of 3-D to create implant treatment
of use and support plans, they will be making an investment in
that helps me prac- their clinical skills and improving their pa-
tice with the great- tients’ experiences and outcomes. This will
est amount of confi- lay the groundwork for increasing treatment
dence. acceptance rates and implant practice
growth. 7
I use the i-CAT
cone beam 3-D unit,
which offers many About the author
valuable features, in-
cluding flexible im- Dr. Gary Orentlicher is Chief of Oral and
aging control. This Maxillofacial Surgery at White Plains Hos-
allows me to custom- pital in White Plains, New York. He is a dip-
ize my scans by min- lomate of the American Board of Oral and
imizing the field of Maxillofacial Surgery, a fellow of the Amer-
view and radiation ican Association of Oral and Maxillofacial
dosage while maxi- Surgeons, and a member of many regional
mizing resolution. and national dental and oral and maxillofa-
With i-CAT, I gain cial surgery organizations. He is a partner
greater control over in the New York Oral, Maxillofacial, and Im-
my workflow and the plant Surgery private practice in Scarsdale,
entire scanning pro- New York.
Treatment planning software used for fully edentulous patients. cess.