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ePaper created 2017-10-13, 10:01:15 | version 1.38.0
A c c u r a c y o f c o m p u t e r - a s s i s t e d i m p l a n t p l a c e m e n t Fig. 3 Fig. 3 Merging of CBCT, DICOM and STL files. Frontal and cross-sectional views of virtual implant planning used to create the surgical templates. using the software’s best-fitting repositioning tools. At this point, the size and location of pros- thetic-driven implants/abutments were planned, taking into account the bone quality/ quantity, soft-tissue thickness, anatomical land- marks, and the type, volume and shape of the final restoration (Fig. 3). After careful functional and esthetic evaluation and final verification, the prosthetic-driven plan was approved, and a stereolithographic surgical template was fab- ricated with a newer rapid prototyping technol- ogy (New Ancorvis, Bologna, Italy). One hour before implant placement, all of the patients underwent professional oral hygiene, used a prophylactic antiseptic contain- ing 0.2% chlorhexidine (CURASEPT, Curaden Healthcare, Saronno, Italy) for 1 min and received prophylactic antibiotic therapy (2 g of amoxicillin or 600 mg of clindamycin if allergic to penicillin). In the control group, the accurate fit of the sur- gical templates was tried on the master model and tested in the patient’s mouth, while in the fully guided group, the fit of the surgical tem- plate was tried directly in the patient’s mouth to fit (Fit Checker, GC, Tokyo, Japan). All of the patients were treated under local anesthesia using articaine with 1:100,000 epinephrine, administered 20 min before surgery. The surgical template was stabilized in relation to the oppos- ing arch using a silicone surgical index, derived from the mounted casts (control group) or from the virtual plane (fully guided group), and two to four preplanned anchor pins. Hopeless teeth were extracted after implant placement in order to improve the stability of the surgical template and to align the pre- and post-surgical scans. In the case of immediate post-extractive implants, residual teeth were extracted as atraumatically as possible imme- diately before surgery. Residual gaps were filled using a synthetic hydroxyapatite enriched with magnesium (SINTlife, Finceramica, Faenza, Italy) or with beta-tricalcium phosphate (Q-Oss+, Osstem, Seoul, South Korea). Sinus lift procedures were performed using minimally invasive transcrestal sinus floor elevation (Crestal Approach Sinus KIT, CAS-KIT, Osstem).12 The bone graft material was based on autoge- nous bone collected at the implant site, com- bined with a synthetic hydroxyapatite enriched with magnesium (SINTlife) or with beta- tricalcium phosphate (Q-Oss+). Planned implants (Osstem TSIII, Osstem) were placed flapless or with a minimally inva- sive flap using dedicate drills (OsstemGuide Kit [Taper], Osstem), according to a fully guided Journal of Oral Science & Rehabilitation Volume 3 | Issue 3/2017 11