implants - international magazine of oral implantology International Edition

I research 18 I implants4_2013 Thepatientsselectedforthetrialweresubsequently divided into three groups of ten each, according to the followingcriteria: − Group 1: Ten patients undergoing implant site preparation through exclusive use of conventional dental drills, dedicated to the corresponding im- plant system. − Group 2: Ten patients undergoing implant tech- nique with site preparation carried out only using piezoelectric inserts. − Group 3: Ten patients undergoing initial prepara- tion of the implant site with piezoelectric inserts, while the final phase of preparation of the same surgical site was completed with the burs specifi- cally dedicated to the implant system (technique proposed by the authors and subject to the verifi- cation of this study). For each patient treated—after a specific consent form—samples of bone tissue were taken during sur- gery at the area corresponding to the implant site, im- plementing the three different methods described above,inordertocompare,histologically,theextentof bone tissue damage created during each different preparationmethod. All patients treated were subjected to antibiotic therapyasfollows: −Amoxicillin+Clavulanicacid1gtablets,1tabletevery 8 h (3 tablets/day) for 6 days, Start therapy p.o. (by mouth)1daybeforesurgery. Allpatientswerealsoprescribedpost-surgicaldaily mouthwashes with 0.2% Chlorhexidine Gluconate up totheremovalofthesutures.Allpatientsweresutured with Ethicon Vicryl Plus 4.0®, braided synthetic ab- sorbable suture, Triclosan-coated, in order to improve preventionagainstsurgicalsiteinfection.Therefore,ac- cordingtotheaboveparameters,atotalof64implants were inserted, including 28 in the lower jaw and 36 in the upper jaw. The 36-month follow-up after surgery alsoincludedthefollowingsteps: − 1 intraoral X-ray examination approximately every month; −1intraoralX-rayexaminationwhenuncovering; −1intraoralX-rayexaminationattheendofdefinitive prosthesisplacement; −1 intraoral X-ray examination every six months after definitiveprosthesisplacement. As regards the prosthesis, the following criteria were chosen and applied: − Traditional prosthesic timing (a waiting time of three months for the implants placed in the mandible (lower jaw) and six months for those placed in the maxilla (upper jaw). − ISQ value detected through Ostell® compared with that recorded at the end of the surgical procedure. − Prosthetic procedure with provisional abutment and provisional, screwed resin crown. − Reduced intercuspidation of posterior elements. After an appropriate period of load and clinical and functionalchecking(onaveragethreemonths)thede- finitive prosthesis was placed, always subject to verifi- cation of the ISQ value, by placing the titanium abut- menttightenedwithatorquewrenchaccordingtothe instructionsoftheimplantcompanyandcementingthe metal-ceramic crown with ImplaCem Precision (Den- talica). The following steps were carried out for the preparationoftheimplantsiteswiththemixedtech- nique object of this trial. Fig. 10_Implant in site. It is visible the neck profile exposed in the vestibular aspect. Fig. 11_Implant site preparation with the authors suggested technique: first steps with piezo inserts. Fig. 12_Final preparation of the same area with drills suggested by the implant company. Figs. 13 & 14_Implant site preparation with rotating instruments. Figs. 15 & 16_It is evident how the bone chips remain around the drill. AD Fig. 14 Fig. 15 Fig. 11 Fig. 12 Fig. 13 Fig. 10