implants - international magazine of oral implantology

I case report Fig. 10_Postoperative OPG. plantation is conducted six to twelve months af- ter radiation, although the temporal interval be- tween radiation and implantation has not been shown to have any influence on the prognosis of the implant.11 The amount of time taken by the healing process is a different story. Here, a period of up to six months is average. Principally, bone augmentation after radiation therapy must be avoided.1 Resulting from the necessity to min- imise risks, three-dimensionally planned implant insertion is indicated, making flapless implanta- tion and avoiding augmentation possible. Special local conditions often lead to an increase in the implant number in comparison to non-radiated patients. Clinical case A 70-year-old female patient presented with a circular hybrid bridge in regio 16–26 with abut- mentteeth12–23andimplantsinregio16,14,13, 24, 25, 26 (Fig. 1). The mandible was edentulous and a removable prosthesis for teeth 36–46 was installed. The patient wished to have a fixed pros- thesis for her lower jaw. She was diagnosed with a malign tumour of the salivary glands in 2009. As part of the pre-radiotherapeutic measures, all teethwereextractedfromthemandible.Oncolog- ical treatment followed as a combination of radi- ation and surgical therapy. The tumour was re- movedintotoandnorelapsesoccurredduringthe frequent recall sessions. Individual risk analysis andtherapyplanningwereconductedinourprac- tice. This included: identification of the radiation date, dose and the dose distribution in the head. Judging from the overall oncological prognosis of thepatient,thisallowsforestablishinganindivid- ual risk profile. For an absolute risk minimisation, template-guidedimplantationbasedonthree-di- mensionaldata(CBCT)wasindicated.Weaimedat making flapless operation without denudation of the radiated bone by template-guided implanta- tion. Virtual implant planning (IMPLA 3D, Schütz Dental GmbH, Germany) gave the additional ben- efit of using the pre-existent bone material in to- tal, with the aim of avoiding augmentative proce- dures (Fig. 2). With regard to the implant progno- sis of radiated patients and the target of avoiding gingiva-based support, eight implants were planned in regio 36–46 for a conditionally remov- able bridge. OPG was used as a postoperative im- aging procedure (Fig. 10). Surgical procedure As an adjuvant preoperative measure, the oral cavity was treated antiseptically (chlorhexidine 0.2%). Perioperatively, a systemic antibiosis was conducted (amoxicillin, 24 hours before surgery). After local anaesthesia, the template was posi- tioned (Fig. 5), and eight pilot drills were per- formed. Expansion drills were done according to themanufacturer’sprotocol.Aftercarefulinspec- tion of the drills via button probe, eight implants (IMPLA Cylindrical, Schütz Dental GmbH, Ger- many) were inserted (Fig. 8). By avoiding any inci- sions,suturesbecamedispensable.Punchedareas were left to heal by themselves, based on granula- tion tissue formation (Fig. 9). Conclusions Positive long-term results prove the good prognosisforendosseousimplantsintheradiated jaw, which have a five-year survival rate of 72–92%.1 However, it must be pointed out that these positive research outcomes were only achieved taking strict perioperative precautions andbyclosemonitoringofthepatient(implantre- call).2 An individual risk analysis and precise plan- ning will support psychosocial integration by im- plant-supported rehabilitation of the masticatory function with predictable results._ Editorial note: A list of references is available from the publisher. 34 I implants2_2013 Dr Umut Baysal Dr RainerValentin Deutzer Freiheit 95–97 50679 Cologne,Germany u.baysal@gmx.de _contact implants Fig. 10