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F i x e d - r e m o v a b l e s o l u t i o n f o r a t r o p h i c m a n d i b l e s with 0.2% chlorhexidine for 1 min. The surgical template (New Ancorvis) was fitted in the pa- tient’s mouth, then local anesthesia was admin- istered with a 4% articaine solution with 1:100,000 epinephrine (Ubistein, 3M ESPE, Milan, Italy). The implants were placed in the planned anatomical sites according to a one- stage approach (Figs. 2a & b)15 using the surgical template. Each patient received four Osstem TSIII bone level implants (Osstem TSIII, Osstem, Seoul, South Korea), placed either without a flap or with a minimally invasive flap, according to the drilling protocol recommended by the manu- facturer (OsstemGuide Kit). After surgery, the existing removable complete denture was re- lined chairside (Sofreliner Tough Soft, Tokuyama Dental, Montecchio Precalcino, Vicenza, Italy) to accommodate the healing of the hard and soft tissue, thereby ensuring no pressure on the heal- ing abutments. Occlusion was checked during osseointegration of the implants. After implant placement, all of the patients received oral and written recommendations on medication, oral hygiene maintenance and diet. Analgesics (500 mg of paracetamol plus 30 mg of codeine, or 600 mg of ibuprofen) were ad- ministered as needed. Eight weeks later, a de- finitive impression was taken using plaster (Snow White Plaster No. 2, Kerr, Orange, Calif. U.S.) as both splinting and impression material (Fig. 3).16 A complete mounting technique was used to articulate the opposite arch cast (KaVo PROTARevo 7, KaVo Dental, Biberach, Germany). Then, esthetics and function of the final occlusal vertical dimension, tooth position and interoc- clusal record were verified and approved by both the clinician and the patient at the try-in ap- pointment. Afterward, the master cast and the try-in were digitalized with an optical scanner (Identica T500, Medit, Seoul, South Korea). A CAD/CAM titanium bar was virtually de- signed (Figs. 4a & b) according to the ridge and prosthetic contours and implant position in order to enhance a vertical path of insertion of between 4 and 6°. Then, a one-piece titanium bar was manufactured (Fig. 5) from a homoge- nous solid block of a medical titanium alloy (Ti6Al4V, New Ancorvis). Four to five threadable OT Equator attachments (Rhein 83, Bologna, Italy) were placed along the implant bar. The fit of the implant bar was clinically and radiograph- ically tested in the patient’s mouth according to a previously published protocol.17, 18 A cast cobalt–chromium alloy metal framework (Vital- lium, DENTSPLY International, York, Pa., U.S.) Journal of Oral Science & Rehabilitation Volume 3 | Issue 2/2017 35 Figs. 4a & b a b Fig. 5 Figs. 4a & b CAD/CAM images showing the titanium bar project, according to the prosthetic volume of the overdenture (a) and the relationship between the titanium bar and implants placed (b). Fig. 5 CAD/CAM titanium bar.