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ePaper created 2017-01-25, 09:48:20 | version 1.38.0
17 1_2017 expert article _ chirurgia guidata a specially designed radiographic stent.21 This study followed the Strengthening the Reporting of Observational Studies in Epidemiology guide- lines.22 _Materials and methods This retrospective study evaluated data col- lected from 27 consecutive patients of both sex- es (19 females, 8 males), aged 18 years or older (range of 38–84; mean of 60.6), presenting with failing maxillary dentition, confirmed by clinical and radiographic examination, and with a pref- erence for a complete-arch implant-supported fixed dental prosthesis or an intolerance to a complete removable dental prosthesis. All of the implants were placed without elevation of a flap in maxillary post-extraction sockets or healed sites using computer- assisted template-guided surgery (Nobel- Guide, Nobel Biocare) between September 2009 and October 2012. The patients were clinically followed for a minimum of two years (range of two to five years; mean of 29 months). All of the patients were treated in a sin- gle specialized implant rehabilitation center. Two clinicians performed all of the surgical (GP) and prosthetic (TC) procedures, and two dental lab- oratories manufactured all of the restorations. One independent examiner (EP) conducted a ret- rospective chart analysis of the 27 consecutively implanted patients with compromised dentition in the maxilla. Patients were informed about the clinical procedures, materials to be used, bene- fits, potential risks and complications, as well as follow-up evaluations required for the clinical trial, and gave their written consent to take part in this study. All of the procedures were conduct- ed in accordance with the Declaration of Helsinki of 1975 for biomedical research involving human subjects, as amended in 2008. The patients were not admitted to the study if any of the following exclusion criteria were present: general contrain- dications to implant surgery; subjected to irradia- tion in the head and neck area less than one year before implantation; untreated periodontitis; poor oral hygiene and motivation; uncontrolled diabetes; pregnant or nursing; substance abuse; psychiatric problems or unrealistic expectations; severe bruxism or clenching; immunosuppressed or immunocompromised; treated or under treat- ment with intravenous amino-bisphosphonates; lack of opposite occluding dentition or prosthe- sis in the area intended for implant placement; active infection or severe inflammation in the area intended for implant placement; and need of bone augmentation procedures at implant placement. _Diagnostic protocol The patients’ medical histories were recorded and preoperative photographs (Fig. 1) and radio- graphs, including periapical (Figs. 2a & b) and panoramic radiographs, were obtained for initial screening and evaluation. Before implant place- ment, all of the patients underwent a cone beam computed tomography (CBCT) scan (New Tom VGi, Quantitative Radiology, Verona, Italy) ac- cording to a double-scan protocol.10 A two-piece radiographic guide was used for the diagnostic Fig. 1_Initial clinical situation of a female patient with hopeless teeth in the maxilla. Fig. 1