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ePaper created 2016-01-07, 12:59:38 | version 1.38.0
case report I 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 positioning and orientation of the implants to anticipate the di- mensions, locations and axes of the im- plantsandabutments.Italsoallowsmax- imal exploitation of the available bone volume (Figs. 3a–c). Implantsurgery Inordertotestthemechanicalresist- ance of the grafted areas on probing, os- teogenic stimulation of the sinus filling materialwasperformedwithbonematrix Osteotensors (Victory), using the tech- nique 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 activatesthecells.Thiseasyandminimallyin- vasivetechniqueenablestheassessmentofthe qualityoftheintendedimplantsites.Thesetech- niques have been successfully used in ortho- paedicsurgeryforadecade.Giventhegoodresponse 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-unitabutmentswere thenplacedanddefinitivelytorquedto25Ncm.Next, a pop-in impression was taken using a polyether im- pression material (Impregum, 3M ESPE) in a custom tray made by the laboratory technician.Forfullimpressionsonmulti- ple implants, we usually prefer to take a pick-upimpression,withjoinedimpres- sion transfers, but this technique could not be used here because of limited mouth opening. I 27implants4_2015 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. Fig. 3b Fig. 3c Fig. 4a Fig. 4b