implants - international magazine of oral implantology

I research 10 I implants3_2013 Figs. 13–18_Crestal incision and subperiosteal dissection of the alveolus, removal of the fixation screws. Implant site preparation with guidance from the laboratory-made splint. Positioning of the implants. Table3showsthefrequencyofcausesforthetoothloss. Allthepatientswereinformedinadvancethatbonere- constructionmightbenecessarypriortoimplantplace- ment,sincetheneedtoaugmentthealveolarridgecan be evaluated correctly using panoramic radiographs onlywhenthereisverticalresorptionoftheridge.Con- ventionalradiographicexaminationprovideslittleorno information about ridge thickness. Because of this, all the patients of the study underwent, except a conven- tional panoramic radiograph of the jaws, CT scans re- formatted with Dentscan software. In disagreement withotherauthors,webelievethatreformattedCTim- agesalwaysprovideaprecisetreatmentguidewhenthe decisiontograftornottografthastomemadeincriti- cal cases.32 A total of 104 alveolar segments were treated: 22 procedures involved the maxilla and 82 the mandible. In six of the augmented areas on the maxilla posterior,aSinuselevationwasalsoperformed.Fifteen patients included in the study were treated in separate proceduresforaugmentationofdifferentalveolarsites. Each augmented site was studied. 67 procedures were carried out under local anaesthesia and 37 under gen- eralanaesthesia.Allsitesweretreatedinasimilarfash- ion.Thenumberofboneblocks,donorsitesandnumber of implants inserted in each augmented site were also recorded.Thechoiceofdonorsite,leftorright,wasde- termined preoperatively, based on defect morphology andrecipientsitelocation.Whentheaugmentationwas plannedintheposteriormandible,asinglesurgicalfield was needed, thus reducing patient discomfort. The re- cipientsitewashealedcompletelypriortograftsurgery. _Surgical protocol Stage1surgery The bone harvesting procedure was performed us- ing a standardised surgical technique. The anaesthesia of all patients was carried out with UltracainTM D-S (Hoechst Marion Roussel Deutschland, Frankfurt, Ger- many) containing 1:200,000 epinephrine at the donor andrecipientsites.Asingleshotof2,2gamoxicillinand clavulanic acid (Augmentan®, GlaxoSmithKline Con- sumerHealthcareGmbH&Co.KG)or,ifpenicillinaller- gic, 600 mg Clindamycin (Clinda-saar®, MIP Pharma GmbH)aswellas250mgPrednisolon(Solu-Decortin®, MerckPharmaGmbH)wasadministeredintravenousto patientsafewminutespriortosurgery. Theproposedrecipientsiteforthegraftwasexposed priortograftharvestinallcases.Inthismanner,thedi- mensions and morphology of the bony defect were measured, and minimal time elapsed between graft harvestandplacement(Figs.1&2).Figure3presentsthe preoperative situation. The recipient site was prepared andrecontouredwiththeSafescraper(C.G.M.S.p.A.,Di- visioneMedicaleMETA,Italy)bypushingtheendofthe devise toward the bone surface and simultaneously pulling the devise backward. Collection of 2–3 ml of bonewasfeasiblewithameansurgicaltimeoffivemin- utesforharvesting(Fig.4).Thecollectedbonewaspre- servedinasterileenvironmentuntilgrafting.Toaccess theramusarea,theconcavityformedbytheborderbe- tween the ascending ramus and the external oblique ridgewasidentifiedandusedasastartingpointforthe mucosalincision. The incision was made medially to the external oblique ridge and extended mesially toward the buccal aspect of the second molar. Care was taken to ensure thattheincisionwasnotextendedtoofarlingually,pre- venting damage to structures on the lingual aspect of themandible.Amucoperiostealflapwaselevatedsupe- riorly, exposing the lateral aspect of the ramus. The os- teotomy was carried out with an osteotomy kit for Piezosurgery®(Mectron,DeutschlandVertriebsGmbH) andwasstartedanteriorlytothecoronoidprocessatthe Fig. 17 Fig. 18 Fig. 14 Fig. 15 Fig. 16 Fig. 13