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ePaper created 2014-10-07, 09:31:41 | version 1.30.01
case report _ smile design combined with guided implantology I forceps. The radiographic template was positioned in the mouth to verify correspondence between the virtualplanandtheactualclinicalsituation(Fig.20). Using a bite splint, the surgical guide was secured with three anchor pins. The drilling protocol was performedaccordingtotheBrånemarkSystemMkIII guided surgery kit specifications (Nobel Biocare). The six regular-platform Titamax EX Ti implants were placed through the guide’s master cylinders, obtaining more than 50 Ncm torque (Figs. 21 & 22). Sixstraightregular-platformMiniAbutments(height: 1 mm; Neodent) were placed over the implants and torqued at 35 Ncm. The provisional acrylic titanium-reinforced pros- thesis was then mounted over the Mini Abutments, thescrewswerehandtightenedafterocclusioneval- uationandthescrew’sexitholescoveredwithTeflon plugs and a temporary light-cured resin (Fermit N, Ivoclar Vivadent; Fig. 23). Follow-up appointments werescheduledforthree,tenand14dayspost-oper- atively (Figs. 24 & 25). Thereafter, the patient was recalled at one, two, three and four months and no adverse findings were made at these appointments. After four months, the conditioned healing of the soft tissue achieved with the provisional provided a favourable situation for the beginning of the de- finitive restoration process (Figs. 26–28). _Discussion DSD has been met with tremendous acceptance by clinicians worldwide. This can be explained by the simplicity of the process and the ease of trans- mission of clinical information. As reported by Reddyetal.andEspanaetal.,theperceptionofden- tal aesthetics can vary from dentist to dentist, from dentisttolaboratorytechnician,andfromdentistto patient because of their differences in dental edu- cation and the subjectivity of what an aesthetic treatment implies.21, 22 One of the major advantages of the DSD concept is visual communication. The activeinvolvementofthepatientinhisorhertreat- ment plan and the feedback that can be provided mayimprovethetreatmentresultandhelptorealise thepatient’sexpectations.Furthermore,severalap- plications are being explored in the reconstructive surgical field 4 and have thus far shown promising resultsforarestorativelydrivensurgicalprocedure. As has been demonstrated in this case, the person- alised analysis of DSD helps to determinate the po- sitionoftheteethintheanterioredentulousregion. The fabrication of the wax-up and the radiographic template were based on the digital evaluation, and this guided the implant virtual planning. Flapless surgery appears to be a safe treatment modality for implant placement, demonstrating both efficacy and clinical effectiveness,8 and the guided implant surgery concept has definitely im- proved the protocol mentioned. It is also well doc- umented that patients treated according to this approach may have faster tissue healing and a better post-operative course.23–26 Figs. 26a & b_Frontal view at the four-month follow-up (a). Lateral left view at the four-month follow-up (b). Note the maturity and health of the soft tissue, and the natural integration of the provisional. Fig. 27_Radiographic follow-up at four months. Fig. 28_Comparison between the initial clinical situation and four months after the surgical restorative procedure. I 27cone beam3_2014 Fig. 26bFig. 26a Fig. 28 Fig. 27 CBE0314_22-28_Lanis 30.09.14 15:11 Seite 6