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CAD/CAM - international magazine of digital dentistry

I 29 case report _ guided surgery I CAD/CAM 3_2013 Surgicalprocedure Owing to the impaired vasoconstriction, adren- aline-free local anaesthetic was administered pre- treatmentwithonesubsequentinjectionduringthe operation. Extraction of the central and left lateral incisorswaswithoutcomplication.Acentralcrestal incision was made with little crestal bone denuda- tionandnoreliefincision.Theanticipatedreduction of the transverse bone then became clearly visible, and bone spreading was performed and two NNC implants were placed (Fig. 3). The insertion sites in the region of both left premolars were prepared by manually shaving the bone until an even bone plateau had been created. The autologous bone chipsgainedherewerelaterusedforboneaugmen- tation in the left central incisor area. Once the implant sites had been carefully pre- pared by means of bone spreading (Fig. 4) and the final implant cavities drilled, the prepared bone was meticulously examined with a bulbous probe and gauges from the Straumann surgery set. The two NNC implants were then inserted into the controlled, intact bony structures (Fig. 5). An NNC SLActive implant of 3.3 mm in diameter and 14 mm in height was inserted in the region of the first pre- molar, and the 3 mm reduced-height NNC healing cap was used for both the implant seal and for pri- marysoft-tissueconditioning.Wedecidedtousean NNCSLActiveimplantof3.3indiameterand12mm in height and the matching 3 mm closure screw for the region of the second premolar. Once this stage of the operation was complete, restoration of the alveolar bone in the central ante- rior region was performed. The immediate implan- tationofaStraumannBoneLevelimplantof4.1mm in diameter and 10 mm in height fitted with the 0.5 mm Regular CrossFit Connection closure screw was then performed. The walls of the alveolar bone were undamaged, and there was primary implant stability.Asasufficientamountofautologousbone chipshadbeengainedfrommaxillarycrestlevelling inthepremolararea,thiswasusedasavolumefiller for bone augmentation. The distance between the bodyoftheimplantandthewallofthealveolarbone that required augmentation was 1–2 mm. Vertical bone augmentation was performed, and there was a slight overlap owing to a platform switch at the implant shoulder. Restoration of the alveolar bone around the lateral incisor was performed using Fig. 15 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14