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ePaper created 2015-06-05, 15:15:11 | version 1.38.0
I case report 10 I implants2_2015 Fig. 11_Three months post-op: frontal anatomical shaping of the jaw, sufficiently thick attached gingiva. Fig. 12_Occlusal view: reconstructed hard and soft tissue, ready for implant insertion. Fig. 13_Two-component sleeve for CT-planning incorporated in the prosthetically correct implant position. Fig. 14_Full length of the Ø 2.2 mm sleeve was utilised initially. Fig. 15_Pilot drilling is deepened through the 4 mm high sleeve section. Fig. 16_Skeletonised implant template creates the largest possible space for the head of the angled handpiece for pilot drilling. Fig. 17_Exposure of jaw bone and removal of two osteosynthesis screws. Fig. 18_Insertion of skeletonised implant template. protect against resorption. The bone augmentation was covered with a resorbable Bio-Gide membrane (Geistlich) cut to size. A periosteal slit allowed maxi- mum mobilisation of the flap which was shifted coro- nally.Usinghorizontalmattresssuturesitwasadapted tension-free to the wound edges and sutured tightly with individual button sutures. Precise wound edge adaptation is a precondition for interference-free wound healing.4-6 The radiographic control image (Fig. 10) shows the fixated bone block in region 21 and the donor site on the Corpus/Ramus mandibulae. The flipperwiththeshortenedplastictoothwasinsertedas temporaryrestoration(Fig.11).Onlylittlepressurewas tobeexertedonthetissueduringbonehealing.Thisre- quiredunderstandingbythepatientandmodified(eat- ing) behaviour. After ten days the patient visited for a check-upandremovalofthesutures.Threemonthsaf- tersurgery,thenaturalalveolarboneprofilewasstable and with a sufficiently keratinised gingiva (Fig. 12). An impression of this situation was taken and an implant templateprepared. The dental technician fabricated a skeletonised template. A two-component sleeve for CT-planning wasincorporatedattheprostheticallycorrectimplant position7,8 andtheplasticreducedasfaraspossiblebe- tween the adjacent teeth. This reduction also enables placing of the template during the surgical procedure with mucoperiosteal flaps and provides maximum space for the angled handpiece during preparation of theimplantbed(Figs.13–16). _Implantation Implantation was performed four months after bone augmentation. Following local anaesthesia, a vestibular flap was prepared, the jaw bone exposed andthetwoosteosynthesisscrewsremoved(Fig.17). Pilot drilling was performed with the aid of a drilling template through the two-component CAMLOG sleeve for CT planning (2.2 mm diameter; Fig. 18). All other drilling steps to prepare the implant site for the CAMLOG® SCREW-LINE implant, length 13 mm and diameter 4.3 mm, were performed without a template. Placement of the implant was performed three- dimensionallyfollowingthecriteriafortheanatomic windowaccordingtoGomezandtakingintoaccount the biological conversion processes associated with implantrestorations.Inthispatientcasetheimplant shoulderrested1–2mmbelowthecemento-enamel junction of the adjacent teeth. The implant shoulder wasplacedapproximately2mmpalatinaltotheden- talarchinoro/vestibulardirection.Apicalplacement compensates for differences between the anatomi- cal emergence profile of the crown and the implant diameter. The mesio/distal distance between the outer edge of the implant to the adjacent tooth should be approximately 2 mm (Figs. 19 & 20). The Fig. 14 Fig. 16Fig. 15 Fig. 11 Fig. 13Fig. 12 Fig. 17 Fig. 18