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ePaper created 2014-11-23, 21:56:20 | version 1.30.01
tion criteria apart from the routine assessment of their suitability to undergo implant surgery, good overall physical status (ASA 1 or 2) and at least one missing tooth in positions 15–17, 25–27, 35–37 or 44–47. At the implant site, they had to have a verti- calboneheightbetween6.5mmand8.0mm,aswell asaminimalbonewidthof6.0mm,assessedbyvir- tual implant placement using SIMPLANT software (Materialise Dental). This is based on a native image obtained by cone beam computed tomography (CBCT). Particular attention was given to maintain- ing a 2 mm safety zone from the mental nerve to avoid any trauma during the surgery due to an ini- tial radiographic error. Moreover, patients had to present with a normal occlusion(noopenbite),includinganopposingarch offering adequate occlusal support. Implants were not placed in heavy smokers (more than five ciga- rettes per day); patients with heavy bruxism, un- treated periodontal disease or poor plaque control; or a position where an implant had been lost previ- ously.Implantswereinsertedintohealedbone;that is, implant placement was performed at least three monthsaftertoothextraction.Nocrestalboneaug- mentation was performed. Eligible patients were informed about all of the availablealternativetherapeuticoptions.Theywere includedonlyiftheyagreedtotreatmentwithshort implants. The participating patients were therefore not exposed to any additional risk and this case se- rieswasthereforenotqualifiedasresearch.Incom- pliancewithvalidethicalrequirements(Declaration of Helsinki, October 2013), the patients were in- structed about the details of their participation and a written informed consent form was explained to them and signed prior to any intervention. Surgicalprocedure The standard surgical one-stage procedure was performed under local anaesthesia. Patients re- ceived antibiotic premedication 1 hour before sur- gery (2 g amoxicillin or 600 mg clindamycin if aller- gic to penicillin) and rinsed for 1 minute with a 0.15% chlorhexidine mouthwash. Thedrillingprotocolwasperformedaccordingto the manufacturer’s recommendations. The bone quality (D1–D4) was recorded in the patient’s chart. The insertion depth of the implant was determined by the anatomy of the surrounding bone. Particular attention was given to avoiding contact between any rough surface and the soft tissue. The implants used were titanium implants of 6.5 mm in length and with a 1.0 mm polished collar, and platform diameters of 4.0, 4.5, 5.0 or 6.0 mm. They had a hydrophilic, moderately rough endosteal surface (ELEMENT implant RC INICELL, Thommen Medical). At the end of the surgery, patients were in- structed to apply standard mouth hygiene proce- dures, including rising with a chlorhexidine mouth- wash immediately after implantation. Paracetamol 1 g every 6 hours was given for 48 hours. No antibi- otic or anti-inflammatory medication was pre- scribed after implant placement. The sutures were removed after one week. Restoration The implants were occlusally loaded with resin temporary crowns between eight and 12 weeks af- ter surgery. For permanent prosthetics, patients were referred back to their dentist at least two months later. As a result, some of the restorations were still provisional at the final examination. Implantstability Theimplantstabilitywasassessedbytactileinves- tigation.Theimplantswereconsideredtobestablein theabsenceofanysignsofmobility,pocketing,bleed- ingonprobingorpainduringtheinvestigation. Follow-up The patients were followed up two months after loadingandfollow-upvisitswerescheduledatleast onceperyear.Theroutinefollow-upprogrammein- cluded oral hygiene reinforcement, scaling and ra- diographs (when needed). I research Fig. 2_Three implants placed in the right mandible; a) buccal view; b) occlusal view. The healing abutments were removed after two months of transgingival healing. 10 I implants4_2014 Fig. 2a Fig. 2b