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Journal of Oral Science & Rehabilitation Volume 2 | Issue 3/2016 55 I m m e d i a t e l o a d i n g u s i n g g u i d e d s u r g e r y Figs. 6a & b Fig. 6c Figs. 6a–c Radiographic situation after implant treatment at five years of follow-up. plant siteswere prepared according to the man- ufacturer’s guidelines. Furthermore, a guided screwtapping was performed for halfthe depth of the osteotomy site, in order to provide an ac- curate and passive pressure-free seating of the implant into the prepared osteotomy. The bone tap was performed as the last step immediate- ly prior to implant placement. Care was taken not to overheat the bone during the tapping procedure. The bone taps were removed from the sitethrough counterclockwise rotation. Both tapping and implant placementwere performed at 20 rpm. In the healed sites, the implant plat- form was positioned at the bone level, while in immediate post-extraction sockets,the platform was placed 1 mm deeper, below the buccal bone crest, engaging at least 3 mm of the bone apical to the root apex to achieve adequate primary stability of at least 35 N cm (range of 35–70 N cm; mean and standard deviation of 57.1 ± 13.4 N cm). The residual gap between the buccal bone plate and the implant surface was filled with a mixture of autogenous bone and freeze-dried deproteinized bovine bone (Geistlich Bio-Oss, Geistlich Pharma, Wolhusen, Switzerland). In extraction sockets presenting severe buccal bone dehiscence, the socket was sealed with a collagen membrane (Geistlich Bio-Gide, Geist- lich Pharma) or with a connective tissue graft and left to heal without implant placement. All ofthe implants were immediately loaded with a metal-reinforced, screw-retained acrylic resin provisional restoration without any canti- lever. All of the restorations were prefabricated on a master cast poured from the surgical tem- plate, with the implant replica on-site. Non- engaging titanium temporary abutments were connected at the implant or abutment level.The provisional restoration was placed in the mouth and assessed for passive fit around the abut- ments. If anytension was detected, more space was provided byadjustingthe provisionalrestor- ation. Once the prosthesis had been completely seated, a preliminary occlusal adjustment was performed. Using a disposable syringefilledwith a cold-cure acrylic resin, the abutments were then connected to the temporary restoration by injecting the resin into the space between the abutments and the framework, having the pa- a c b Volume 2 | Issue 3/201655