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Blue Curved Tubes
Digital Workflow for Immediate Implant Placement with 4-week Early Loading

Case Summary 🔎


Patient Information

  • Date: 2024-06-19

  • Patient Information: 68 years old, Female

  • Medical History: None

  • Chief Complaint(C.C): Severe pain and mobility in the upper right tooth


Treatment Plan

  • Extraction of tooth #16

  • Implant placement using Digital Guide (VAROGuide)

  • VAROGuide initial drilling ▶ Maxy kit ▶ IT-III implant placement

  • Connection of scan body followed by intraoral scan


Results

  • Product Used: ITW32 Ø5.0X10mm (ITW325010AP)

  • Bone Quality: D2-3 (C2-3M2-3I2-3) – CMI Fixation

  • ITV: 40 N/cm

  • ISTV: 83

  • Connection of scan body followed by intra-oral scan

  • Zirconia implant (SCRP type) setting after 4 weeks


Case Presentation


1️⃣ Pre-Op

  • Pre-Op X-ray & Intraoral Photo



2️⃣ Surgical Plan

  • #16 VAROGuide Implant planning

  • Implant Size : 5.0X10.0 / Sleeve Offset : 9mm

#16 VAROGuide Implant planning

3️⃣ Surgery

1) #16 extraction



2) VAROGuide placement

2) VAROGuide placement

3) Using the VAROGuide drill sequence from the initial drill to the Ø4.5 final drill, bone quality at all C, M, I parts was D2-3

3) Using the VAROGuide drill sequence from the initial drill to the Ø4.5 final drill, bone quality at all CMI sites was D2-3

4) After Ø2.2 drilling and Ø4.5 drilling



5) Forming the appropriately sized thread for the fixture with pre-tapping(Ø5.0X10mm) by hand



6) Formation of internal threads

6) Formation of internal threads

7) Flattening the alveolar bone using a denture burr

7) Flattening the alveolar bone using a denture burr

8) Implant placement of ITW3 Ø5.0 x 10mm (Gingiva cuff 2mm)

8) Implant placement of ITW3 Ø5.0 x 10mm (Gingiva cuff 2mm)

9) Implant placement with an ITV of 40N/cm in D2-3 bone quality

9) Implant placement with an ITV of 40N in D2-3 bone quality

10) Bone grafting was performed using Neobone Plus, which is a synthetic bone graft material

10) Bone grafting was performed using Neobone Plus, which is a synthetic bone graft materia

11) Connected a Ø7.3X3mm healing abutment, ISTV measured 83 with Anycheck

11) Connected a Ø7.3X3mm healing abutment, ISTV measured 83 with Anycheck

12) After connecting the scan body, an impression was taken with the i-700 intraoral scanner


4️⃣ Post-Op

  • Post-Op Panorama

Post-Op Panorama

5️⃣ Post-Op Follow-Up

  • At the 2-week follow-up, the ISTV measured 82

At the 2-week follow-up, the ISTV measured 82

  • At the 4-week follow-up, the ISTV remained stable at 84, and the final prosthesis was subsequently set

At the 4-week follow-up, the ISTV remained stable at 84, and the final prosthesis was subsequently set

6️⃣ Final Prosthetics: 4-week Early Loading

  • The prosthesis was fabricated on the SCRP type, and the contact box was filled with resin

The prosthesis was fabricated on the SCRP type, and the contact box was filled with resin

  • After intraoral setting, occlusal adjustment was performed, completing the final prosthetics

After intraoral setting, occlusal adjustment was performed, completing the final prosthetics

  • After final prosthetics


7️⃣ Final X-ray

  • Final Panorama & PA



8️⃣ Results

  • Immediate placement of maxillary molar using VAROGuide

  • Utilized VAROGuide Initial drill – Ø2.2 drill - Ø3.0 drill - Ø3.5 drill – Ø4.0 drill – Ø4.5 Final drill

  • Confirmed bone quality as D2-3 at Ø2.2 drill stage (All C, M, I parts assessed as D2-3)

  • Pre-tapping in D2-3, forming threads optimized for the fixture

  • IT-III2 Ø5.0X10mm (ITW325010AP) placement

  • Additional bone grafting with Neo Bone Plus (Synthetic bone)

  • Achieved good fixation with ITV 40N and ISTV 83, followed by scan body connection and impression taking on the same day

  • ISTV maintained well at 82 after 2 weeks and 84 after 4 weeks

  • 4-week zirconia implant crown setting with early loading

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