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ePaper created 2018-01-31, 10:01:59 | version 1.38.0
Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 5: Placement of an SDI as anchor mount. Fig. 6: Connecting the NaviStent Arm to the SDI. Figs. 7 & 8: Adjusted scan prosthesis for combined scanning. Fig. 9: Connecting the CT marker to the NaviStent. Fig. 10: Patient positioning in the CBCT scanner. location and diameter of implants can be modified and a flap can be incised intraoperatively whenever needed. fidence. In the initial appointment he thus stresses his need for a “fixed solution”. Furthermore, dynamic navigation enables the surgeon to adjust the surgical plan during surgery. In case of an unexpected low bone quality, an additional implant could be planned with the software and placed additionally. Moreover, one of the most significant benefits of dynamic navigation is the ability to use it also for alveoloplasty and reshape the alveolar crest’s topography during the same surgery, together with the implant placement. The precise location of implants is case-specific and determined by different factors. If an edentulous case is to be restored with an implant-supported screw-retained fixed prosthesis, implant locations should be critically ex- amined whether they can provide screw access holes within occlusal or palatal/ lingual parts of the restoration. Frequently, alveolo plasty is required for the recontouring of the ridge in order to obtain sufficient bone thickness at the level of the implant’s collar. This crestal trimming of bone may also be necessary in order to increase the inter-arch space and provide a sufficient volume for the restorative material, since den- togingival prostheses are frequently required to enhance aesthetics. In such cases, dynamic guidance can be used to level the alveolar crests as planned on virtual im- ages, followed by precise multiple osteotomies. Case report His medical history did not reveal any specific sys- temic disease or condition that contraindicates oral sur- gery. The patient’s soft tissues on the edentulous ridges were healthy and panoramic X-rays showed expanded sinuses at both sides and irregular alveolar ridges. The treatment plan, carried out for a maxillary screw-retained fixed prosthesis, included two implants at the pre-maxil- lary region and two tilted in the posterior maxilla to avoid a sinus lift surgery. Stent placement In order to acquire both anatomical and prosthetic infor- mation prior to the surgery, a scan prosthesis was man- ufactured by duplicating the maxillary denture (Fig. 2). It is important that the scan prosthesis has the same aes- thetic and functional information as the complete denture or set-up. Thus, the scan prosthesis was checked for its fit, aesthetics and maxilla mandibular relation (Fig. 3). The scan prosthesis was then used together with a Navident Edentulous Kit for CBCT imaging. The Navident edentulous protocol consists of a SDI (Small Diameter Implant of 2.2 mm or 2.5 mm diameter), which is inserted into the alveolar ridge of the arch to be operated, prior to the acquisition of the CT scan. This tem- porary SDI serves as a mount for the CT marker and for the Jaw Tag used for the registration of the CT scan to the patient and for tracking the patient’s jaw during surgery. The following case report describes the treatment of a 65-year-old male with an one-year history of maxillary partial edentulism (Fig. 1). He was discontent with the stability of his prosthesis and expressed that through the unstable prosthesis situation he has lost social self-con- The SDI can be placed either in a vertical position or in a horizontal position in relation to the alveolar crest. A special plastic arm with a proprietary aluminium bracket is then used for the connection of the CT marker and Jaw Tag to the SDI. Two types of arms are available: one for a CAD/CAM 1 2018 41