Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-08-25, 17:58:13 | version 1.38.0
| case report guided implant reconstruction Fig. 10 Fig. 11a Fig. 11b Fig. 12 The original treatment plan conceived by the orig- inal treating dentist was to place four narrow-diam- eter implants in the anterior mandible to support the existing complete denture with overdenture attach- ments, due mostly to financial limitations of the patient. A flapless surgical protocol was chosen, and the initial implant site located by the panoramic radiograph. The panoramic reconstructed view of the edentu- lous mandible may provide the clinician with some information regarding the bony anatomy, but it is not sufficient to plan for implants in the majority of case presentations. It is essential to precisely locate the bi- lateral anatomical sites where the inferior alveolar nerve exits the mandible, and the panoramic radio- graphy cannot provide this information accurately. To plan for the placement of implants, it would be impor- tant to understand the available bone anatomy to de- termine the number of implants that could be placed, and the diameter and lengths required. The 2-D pan- oramic radiograph cannot predict the width, trajec- tory, or density of the bone, as well as the thickness of the overlying soft tissue. Therefore, it can be difficult for a clinician to make truly educated decisions based on two-dimensional imaging modalities. Upon drilling the initial pilot osteotomy prepara- tion directly through the soft tissue, the drill immedi- ately broke ‘in the bone’. A periapical radiograph con- firmed that the drill was broken, and deemed to be ‘in the bone’. The subsequent paper print-out of the dig- ital radiograph can be seen in Figure 6. The clinician reported what happened to the patient, and decided to abort the entire procedure and send the patient to a nearby oral and maxillofacial surgeon. The surgeon examined the patient and decided to let the area heal, and follow-up later for a new plan of treatment. At this time a CBCT was performed by the oral surgeon to better assess the situation. The patient was not Fig. 10: The cross-sectional slices revealing ‘hollow’ areas in the symphysis. Figs. 11a & b: The ‘clipping’ view with simulated implants reveals ‘hollow’ areas in the symphysis. Fig. 12: The mandibular 3-D reconstructed volumes illustrating the hollow areas and potential implant receptor sites. Fig. 13: A full thickness mucoperiosteal flap exposed the knifeedged ridge of the mandibular symphysis. Fig. 14: The broken drill was located lingual to the bony crest of the mandible. Fig. 13 Fig. 14 Fig. 15 Fig. 15: The anterior symphysis revealing the anterior ‘hollow’ symphysis. Figs. 16a & b: The thread design of the AnyRidge implant (a), four implants well-fixated in the mandibular symphysis (b). 28 CAD/CAM 3 2017 Fig. 16a Fig. 16b