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cone beam – international magazine of cone beam dentistry

case report _ use of CBCT in implant dentistry I Fig. 5_Engage dental implant. Fig. 6_Aseptico surgical motor. Fig. 7_Using the pilot guide. Fig. 8_Osstell ISQ unit. I 11cone beam4_2015 (OCO Biomedical) dental implants in the maxillary arch, as well as seven Engage dental implants in the mandibulararchusingCT-basedsurgicalpilotguides (3D Diagnostix; Figs. 3 & 4). The final treatment plan was fixed bridges on im- plantsinthemaxillaryandmandibulararches.Engage implantswereselected(Fig.5)becauseIhaveperson- ally experienced their high implant stability at place- ment, which is a critical success factor during the early healing process of osseointegration with these types of cases. With the combination of its patent- pendingBullNoseAugertipandMiniCortic-OThread, this implant system offers practitioners a bone-level implantwithhighinitialstabilityforselectiveloading options. In fact, the Engage implant body creates a tapping pattern when threaded for an enhanced me- chanical lock in the bone. Other dental implant sys- tems with aggressive threading may include, but are not limited to, NobelActive (Nobel Biocare), SEVEN (MIS Implants Technologies), ET III (Hiossen), I5 (AB Dental) and AnyRidge (Megagen). For effectiveness and greater proficiency during theTotalDentalSolutionsReconstructionprocedures, intravenous sedation should be performed. Not only doesitmaketheappointmenteasier,butpatientsalso prefer to have the treatment completed in one visit. Since the patient is sedated, a mouth prop is needed to keep his or her mouth open. Because of this, teeth are extracted in quadrants, starting from the upper left to the upper right and then down to the lower rightandlowerleft.Thisallowsgreattime-savings,as it is easier to keep the patient’s mouth open and be able to proceed around the arches safely. Once the teeth have been extracted, the tissue has to be re- flected in order to seat thebone-level surgical guides and fix them with their respective retention pins. Us- ingthesepilotsurgicalguides,theosteotomiesforthe implants were begun with a 1.95mm pilot drill utilis- ing the Mont Blanc surgical handpiece (Anthogyr) and Aseptico surgical motor (AEU 7000) at a speed of 1,200rpm with copious amounts of sterile saline (Figs. 6 & 7). Paralleling pins were placed in the sites of the osteotomies to confirm the accuracy of the surgical guideandradiographsweretakentochecktheangu- lationsofthepinswithinthemaxillaandthemandible. Oncetheosteotomieswerecomplete,animplantfin- ger driver was used to place the dental implants until increased torque was necessary. The ratchet wrench was then connected to the adapter and the implants torqued to final depths, reaching a torque level of approximately 40–50Ncm. Adequateimplantfixationwasfurtherverifiedus- ing an Osstell ISQ (implant stability quotient) meter, whichusesresonancefrequencyanalysisasamethod of measurement (Fig. 8). Several studies have been conducted based on resonance frequency analysis measurements and the ISQ scale. They provide valid indications that the acceptable stability range lies above 55 ISQ. Fig. 5 Fig. 6 Fig. 7 Fig. 8

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