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ePaper created 2017-10-13, 10:01:15 | version 1.38.0
F u l l y d i g i t a l w o r k f l o w Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 1 Frontal extraoral view. Fig. 2 Lateral extraoral view. Fig. 3 Existing removable complete dental prosthesis with 6 drops of flowable composite and a wax bite. Fig. 4 Optical scanning of the existing removable complete dental prosthesis. Fig. 5 Three-dimensional STL file of the existing removable complete dental prosthesis. DICOM data with the STL file (Figs. 4 & 5). Using reverse engineering, a virtual model was achieved (Fig. 6). The STL and DICOM data were imported into a 3-D software planning program (3Diagnosys, Version 4.2, 3DIEMME, Cantù, Italy). The repro- cessed surface extrapolated from the DICOM data and the surface of the existing removable complete dental prosthesis generated by the scanning process were merged with the best- fitting repositioning tools of the software (3Diagnosys). At this point, four prosthetic-driven implants with a diameter of 3.5 or 4.5 mm and a length of 13.0 mm (Osstem TSIII, Osstem, Seoul, South Korea) were planned, taking into account the bone quality and quantity, soft- tissue thickness, anatomical landmarks, and the type, volume and shape of the final restoration (New Ancorvis, Bargellino, Italy; Fig. 7). After careful functional and esthetic evaluation and final verification, the prosthetic-driven plan was approved, and a stereolithographic surgical tem- plate was fabricated with a newer rapid proto- typing technology (New Ancorvis; Fig. 8). S e c o n d c l i n i c a l a p p o i n t m e n t One hour before implant placement, the patient underwent professional oral hygiene, used a prophylactic antiseptic containing 0.2% chlor- hexidine (CURASEPT, Curaden Healthcare, Saronno, Italy) for one min and received prophy- lactic antibiotic therapy (2 g of amoxicillin or 600 mg of clindamycin if allergic to penicillin). The accurate fit of the surgical templates was tried directly in the patient’s mouth (Fit Checker, GC, Tokyo, Japan). The patient was treated under local anesthesia using articaine with 1:100,000 epinephrine, administered 20 min before surgery. The surgical template was sta- bilized using a silicone surgical index, derived from the virtual plane, and five preplanned anchor pins (New Ancorvis). Planned implants (Osstem TSIII) were placed flapless using dedi- cate drills (OsstemGuide KIT, Osstem; Fig. 9). All of the implants were inserted with a mini- mum insertion torque of 35 N cm according to previously published protocols.14 Preplanned multiunit abutments were immediately screwed on to the implants (New Ancorvis) and never removed. Immediately after implant placement, the patient received a digital impression (CS 3600 intraoral scanner, Carestream Dental), taken at abutment level, using dedicate scan abutments (Type AQ, New Ancorvis; Figs. 10a & b). In order to improve the accuracy of the digital impression in a fully edentulous patient, a second digital impression was taken using a dedicate opaque template, made by vir- tual planning, that was stabilized in the patient’s 40 Volume 3 | Issue 3/2017 Journal of Oral Science & Rehabilitation