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ePaper created 2017-01-25, 09:48:20 | version 1.38.0
19 1_2017 by infiltration of the buccal and palatal regions of the surgical area with a 4% articaine solution with 1:200,000 epinephrine (Ubistesin, 3M Italia, Bergamo, Italy). Conscious sedation with midaz- olam 0.05–0.15 mg/kg IV (Ipnovel, Roche, Monza, Italy) was performed; ranitidine 100 mg IV (Ran- idil, Menarini, Florence, Italy) and ondansetron 4 mg IV (Zofran, GlaxoSmithKline, Brentford, U.K.) were also administered for gastroprotection and prevention of nausea and vomiting. A single postoperative dose of dexamethasone 8 mg IV (Decadron, Visufarma, Rome, Italy) and ketoro- lac 30 mg IV (Toradol, Recordat, Rome, Italy) was also given. Hopeless teeth were atraumatically extracted with the aid of a periotome (PT2, Hu- Friedy, Chicago, Ill., U.S.) and the sockets debrid- ed. In cases of multiple-rooted teeth, a rhizoto- my was performed, starting from the center of the tooth, followed by careful extraction of the individual roots to prevent damage to the alveo- lar walls. Upon completion of the extraction, the integrity, depth and inclination of the alveolar socket were checked with a periodontal probe. The surgical templates were positioned using the silicone surgical index derived from the mounted casts, and precise fit was visually and manually assessed. The surgical template was then stabi- lized with three to five preplanned anchor pins. All of the implants were placed through metallic sleeves in a fully guided surgery approach. Im- plant sites were prepared according to the man- ufacturer’s guidelines. Furthermore, a guided screw tapping was performed for half the 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 immediately prior to implant placement. Care was taken not to overheat the bone during the tapping pro- cedure. The bone taps were removed from the site through counterclockwise rotation. Both tapping and implant placement were 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 api- cal 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 ex- traction sockets presenting severe buccal bone dehiscence, the socket was sealed with a col- lagen membrane (Geistlich Bio-Gide, Geistlich Pharma) or with a connective tissue graft and left to heal without implant placement. All of the implants were immediately loaded with a met- al-reinforced, screw-retained acrylic resin provi- sional restoration without any cantilever. All of the restorations were prefabricated on a master Fig. 3_Two-piece radiographic stent used for the CBCT scan. expert article _ chirurgia guidata Fig. 3