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ePaper created 2015-03-07, 18:13:20 | version 1.33.01
I case report _ use of CBCT Theplannedsixosteotomieswerecompletedwith the surgical template with embedded guide tubes, and the universal drill key system, which allowed for precise drilling of each osteotomy (Universal Drill Kit, SimPlant,DENTSPLYImplants).Fourosteotomieswere positioned in the posterior mandible and two os- teotomies were positioned in the anterior mandible. Each osteotomy was purposely undersized to insure good stabilization of the implants (Touareg Adin Dental Implant Systems). After the template was removed, each implant was hand-torqued into posi- tion, and ISQ values (Implant Stability Quotient) were obtained (Osstell). Each implant ISQ value was measured to be 68 ISQ or higher, values consistent with immediate restoration.9, 10 All the posterior im- plantswere5.0mmindiameterx6.3mminlength,ex- cept for the implant in the lower left first molar area, whichwas4.2mmindiameterx6.3mminlength.The twoanteriorimplantslocatedinthemandibularright lateral area were 4.2mm in diameter x 16mm length, and the mandibular right second bicuspid area was 4.2mm in diameter x 13mm in length (Fig. 12). Once the new implants were delivered, the Lo- catorabutmentswereremovedfromthethreeorig- inal pre-existing implants, and were substituted with multi-unit screw-receiving abutments which received temporary titanium cylinders (Adin Dental Implant Systems). Additionally, the two anterior im- plants that were just placed also received multi-unit abutments and cylinders for a total of five implants, which were to be loaded. The posterior implants re- ceived cover screws and were buried under the soft tissue after the flaps were repositioned and primarily closed with sutures. A fully extended acrylic denture was first posi- tioned over the implants, and the posterior intaglio surfaces were hollowed to facilitate proper seating of the denture over the posterior cover screws. The purposeofthepinkdenturebasewastohelpstabilize thedenturewhileitwasbeingconnectedtothetem- porarytitaniumcylinders.Oncetheconnectionswere achieved, the pink denture base areas were removed with an acrylic laboratory bur, and the flange area contoured to serve as a fixed implant-supported screw-retained provisional. _Conclusion The process of guided surgical applications for dental implants continues to be refined and im- proved as the software technology and hardware componentsevolve.TheuseofCBCTandinteractive treatmentplanningsoftwarehavesignificantlyim- pacted upon the diagnostic capabilities which aid clinicians in accurately assessing individual patient anatomy,providingincreasedaccuracytodetermine properimplantreceptorsites,locatingvitaladjacent anatomy,andreducingpotentialcomplications.CT/ CBCT-derivedsurgicalguidesplayanimportantrole in taking the virtual plan to the surgical interven- tion.Regardlessofthesurgicalguidetype(mucosal, toothborne,orboneborne),itisimperativethatthe template does not move to ensure accuracy of the drillingprotocol.Stabilitycanbeachievedinvarious ways, including the placement of pins through the host bone, usually required for mucosal templates, Fig. 9_Pre-fitted rubber dam material used at the time of surgical intervention. Fig. 10_Full thickness flap exposing the three pre-existing Straumann bone-level implants and their corresponding Locator abutments. Fig. 11_Once the soft tissue had been completely reflected, the surgical guide was then secured to the middle Locator abutment with the embedded housing, and complete seating was confirmed. 14 I cone beam1_2015 Fig. 9 Fig. 10 Fig. 11