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ePaper created 2015-05-14, 11:05:01 | version 1.38.0
case report _ upper jaw rehabilitation I with lateral access was performed. The space under the sinus floor was filled with allogeneic bone (max- graft,botissbiomaterials)mixedbeforehandwiththe venous coagulum collected at the beginning of sur- gery. The following step entailed covering the allo- geneic bone with a collagen membrane (Bio-Gide, Geistlich) and a platelet-rich fibrin membrane. The complete denture was then hollowed out and relined periodically with a soft resin. Implantationplanning The case was planned using the SIMPLANT (DENTSPLY) treatment planning software. The radi- ographic guide, which is a duplicate of the existing prosthesis, allows the prediction of the po- sitioning and orientation of the implants to anticipate the dimensions, locations and axes of the implants and abutments. It also allows maximal exploitation of the available bone volume (Figs. 3a–c). Implantsurgery In order to test the mechanical resist- ance of the grafted areas on probing, os- teogenic stimulation of the sinus filling material was performed with bone matrix Osteotensors (Victory), using the technique described by G. Scortecci and C. Misch.3 The bone matrix Osteotensors are used in a trans- parietal technique (flapless procedure). This endosteal stimulation also activates the cells. This easy and minimally invasive technique en- ables the assessment of the quality of the intended implant sites. These techniques have been success- fully used in orthopaedic surgery for a decade. Given the good response to osteogenic stimulation, the implantation was planned after 45 days. Six months postoperatively, seven Axiom PX im- plants (Anthogyr) were placed in the upper jaw using theradiographicguide.Self-drilling,self-tappingand featuring a reverse conical neck, the conical, double- threaded implants selected for this rehabilitation (Fig. 4a) allowed us to obtain excellent primary an- choring, as they, along with the drilling protocol, en- courage bone condensation in areas with low bone density. Moreover, the osteoconductive potential of their BCP (biphasic calcium phosphate) grit-blasted surfaces promotes osteoblast differentiation in the early stages of osseointegration. Restorativephase Four months after implantation, preparation for thefinalrestorationbegan(Fig.4b).Apercussiontest on the implants was carried out, and a control radi- ographwastaken.Straightmulti-unitabut- ments were then placed and definitively torqued to 25Ncm. Next, a pop-in im- pressionwastakenusingapolyetherim- pression material (Impregum, 3M ESPE) in a custom tray made by the laboratory technician.Forfullimpressionsonmul- tiple implants, we usually prefer to take a pick-up impression, with joined im- Figs. 3a–c_Implant planning with SIMPLANT after a bilateral sinus lift. Fig. 4a_Axiom PX implant. Fig. 4b_Occlusal view showing the multi-unit abutments and protective caps in place. I 27CAD/CAM 2_2015 Fig. 3b Fig. 3c Fig. 4b Fig. 4a