XiVE® ExpertEase™ - Save and precise in borderline situations

Scan Prosthesis 3D Picture segmented Planning the prosthetic direction – semi transparent bone Planning the implant position – sag cut Stereo-Lithographic drilling template

Template in situ Tissue punching Cleaning the punch holes XiVE Twist Drill GS D 2.0 XiVE Twist Drill GS D 3.0

Exact aligning of the implant The implants in situ immediately after the insertion X – Ray post op Definite Crowns Overview of the reconstructed mandible

Alexander Fischer Billerbecker Weg 104, D-13507 Berlin, Germany Kindly supported by DENTSPLY Friadent

Introduction In situations when the bone supply of the mandible is difficult to determine, 3D CT-based planning gives us a possibility to diagnose exactly. The ExpertEase™ System helps the surgeon to work precisely and gives the patient and the dentist the security not to hurt any important anatomic structure.

Case Report Female patient age 42. Lost her teeth 35 and 36 seven years ago because of caries. The tooth gap had been provided with a bridge from 34 – 37. Tooth 34 had a root filling, a resection and the third degree of tooth mobility caused by too much strength in her muscles of mastication and the loss of the prosthetic value after the root resection in connection with the wide margin of the bridge. Implants were planned in following regions: 34: immediate implantation XiVE S 3.4 L11; 35: XiVE S 3.4 L9.5; 36: XiVE S 3.4 L13. We did a functional analysis with the DIR System (Dynamic Intraoral Registration). After that it was necessary for her to wear a bite splint

Results Because of an inflammation two weeks before the appointed day of the implantation, we had to take out tooth 34. According to this I did not receive the primary stability on the implant 34, as I planned it, so I reassured myself on the ExpertEase™ software and placed the implant 2mm deeper to attain a better solidity. Because of the loss of the primary stability I decided to leave the implants unloaded under the surface of the gingiva. I reconstructed the bite splint. I tooth borne it on 33 and 37, so that the result of the functional analysis was not compromised. After 6 weeks the gingiva has been opened again with the tissue punch through the template and the cover screws were removed and exchanged for gingiva formers. The impression was made with the pickup technique. Ten days after we made the impression I integrated the definite crowns. The implants are osseo-integrated.

Conclusion ExpertEase™ gives us so much precision that the risk of failure or hurting the patient is minimized. On the other hand we have so much freedom that we can change our planning and go on the old fashioned way with the benefit of a 3D CT planning.

twenty-four hours a day to ease the problems of her craniomandibular dysfunction. It was my aim to do an immediate loading with blocked crowns based on the Temp Bases of the three implants with including the tooth 37, so that the patient was able to wear her bite splint to relax her jaws until the definite crowns were made.

Method After scanning the patient with a Cone Beamer wearing a radio-opaque scan prosthesis, the dental data has been converted and segmented by a specialist of DENTSPLY Friadent. The next step for me is to plan the position of the implants after visualizing the nerves. The Stereo-lithographic drilling template is built by Materialise Dental in Belgium without analog sources of error. It allows the dentist to put the implants precisely into the right position. This method makes it possible to insert the implants through the template without building a gingival flap. The mucogingiva has been opened with the tissue punch, so that I have a small operation area. I don’t want to bring the connective tissue into the drilling holes, that’s why the gum has been removed. The guided drills have a drill stop, so it cannot happen that I drill deeper than planned with the ExpertEase™ Software. For the implant site preparation the drills are guided in the surgical template by the sleeves for twisted drills – the surgeon can’t change the direction.