The overall treatment plan for Justin called for removal of the retained lower right deciduous second molar and placement of an implant fixture. Following implant placement, records were sent to Align. Using ClinCheck a proper M-D space was developed for the restoration of the implant fixture. This plan would allow the implant fixture to integrate while simultaneously moving teeth with Invisalign, thus saving the considerable time of implant integration before implant restoration.

I decided to construct a surgical guide to help aid the placement of the implant such that the location of the implant fixture was positioned to optimize the final restoration. The stone model was trimmed and using a drill press a hole drilled in the desired position for the lab implant analogue. A counter-sink of about 3mm was also drilled to represent tissue depth. The lab implant analogue was then secured with light cured gel material. The lab parts were assembled to allow the guide ring to be located in position. Using light cured material the material was formed around the guide ring and over the occlusal of the teeth in the lower right quadrant. The guide material was cured, trimmed and polished. I have included some photos to show the surgical guide.

The surgical procedure went very well. After administration of local anesthetic, the deciduous tooth was sectioned to preserve bone to minimize the trauma during extraction. The guide was placed and using a series of drill guides and bits to complete development of the size of the implant fixture receptor site. Radiographs were taken to quantify the depth. A Nobel RP replace select implant was placed and torque to proper value and a healing abutment placed. As the healing abutment extended above the tissue, a second stage exposure surgery would not be necessary. Two restorable sutures were placed to secure proximal tissue. A final radiograph confirmed the desired location of the fixture. Several photos show the implant.

After a month of time, the soft tissue and implant site were determined to look good, so the PVS impressions, photos and radiograph were taken to send to Align. I have already outlined using ClinCheck to develop the treatment plan in a prior blog. After receiving the aligners, attachments were placed and the aligners delivered.

The first monitoring visit showed an excellent fit of the aligners to the teeth and attachments. The implant site also looked very nice. The next blog will update the next monitoring visits.