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ePaper created 2016-11-23, 14:26:06 | version 1.38.0
| industry 20 implants 4 2016 an increase in volume from the vestibular side for the restoration of correct tissue harmony and a correct emergence profile of the prosthetic crown. Several post-surgical follow-up visits are planned at two, four, seven and 14 days to disinfect the incision with chlorhexidineandtocheckforpossibledehiscenceof the flap. The prosthetic phase will be carried out ap- proximately four months after the positioning of the implant and consists of a zirconia and ceramic crown on a titanium abutment. Surgical phase After plexus anaesthesia, performed with mepiva- caine1:100.000bothinthevestibularandlingualfor- nix, a crestal incision was made without releasing cuts, so as not to reduce the vascularisation of the flap, as predicted by the CBCT (Figs. 3a, b & 4). Flap incision The bone crest appears very thin, but of adequate height for the insertion of an implant of 13 mm (Fig. 5). In order to minimise possible vestibular fen- estrationinthesub-crestalpositioningoftheimplant ofØ 3.75 x 11.5 mm,wedecidedupona13 mmprepa- rationofthesite,beginningthedrillingsequencewith a 2 mm stop drill. The osteotomy was stopped at the 2.8 mm diameter drill (Fig. 6). The implant was in- sertedusingamanualratchetandstabilisedinasub- crestalpositionwithapproximately50Ncmoftorque (Figs. 7–9). Fig. 3a Fig. 3b Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Figs. 3a & b: CBCT with implant planning. Fig. 4: Flap incision. Fig. 5: Occlusal view of the gap. Fig. 6: Preparation of implant tunnel. Fig. 7: Manual insertion of the implant. Fig. 8: Subcrestal insertion of the implant. Fig. 9: Subcrestal insertion of the implant. Figs. 10 & 11: Regeneration with resorbable membrane and heterologous bone. 42016