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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
case report | Fig. 1 Fig. 2 Fig. 1: Radiographic template with three reference balls. Fig. 2: Dental panoramic tomogram after augmentation with iliac crest bone. – allows flapless, minimally invasive surgery, avoiding unnecessary bone exposure, which entails less bleed- ing, less swelling, and a reduced healing time and post- operative pain; – low-distortion and detailed radiographic analysis and an improved learning curve for the dentist, surgeon and dental technician team; – provides greater safety for patients and dentists through 3-D planning, especially with complicated jaw conditions or low bone volume and the risk of post- operative complications is significantly reduced; – virtual planning provides the conditions for consid- erably increased accuracy of implant placement and avoidance of vital structures, followed by the prosthetic restoration of masticatory function; helps in treatment predictability, and promotes the main- tenance of aesthetic and biomechanical principles.11–13 The backward planning for a computer-aided implanta- tion includes the following steps: 1. Impression and model fabrication. 2. Planning of prosthetic restoration. 3. Preparation of a scan template with three reference balls (aluminium, 2 mm in diameter; Fig. 1). 4. CT/CBCT scan of the patient with the inserted scan template. 5. Reading the radiographic data into the CTV system and virtual planning of the implantation. 6. Transfer of the planning data to the drilling template. 7. Guided implant placement. – the operation period is significantly shorter. Case presentation However, computer-assisted implant surgery is not free of risks. Navigated implantology also has certain drawbacks and limitations, which have to be considered as well:10–12 – problems with the template positioning in edentulous jaws and inaccurate fixation of the surgical guide, re- sulting in displacement during the surgery; – fracture of the surgical guide; – dependence between the guide system and software and usually the learning curve for the dentist, surgeon and dental technician team is complex; – reduced mouth opening can lead to changed position- ing of surgical instruments; – the total cost of the tools needed, including the soft- ware program and surgical templates, is higher in comparison with that of traditional methods; In this section, we present two clinical cases of pros- thetic rehabilitation of a patient with extreme alveolar ridge atrophy and a tumour patient with iliac crest bone graft- ing and computer-aided implantation using the CAMLOG Guide System. The preoperative planning, the operation phases and the patient’s postoperative wound healing are described. The study was conducted in the oral and maxillofacial surgery department of St. Lukas Hospital in Solingen, Germany. The patients concerned presented for implant rehabilitation in our department after surgical resection and irradiation and before augmentation of the extreme alveolar ridge atrophy of the lower jaw with iliac crest bone. The insertion of implants was performed after obtaining CBCT scans and virtual planning of the implan- tation using CTV software. – intra-operative modification of implant position is not Case 1 allowed. In computer-aided implantology, the treatment proce- dure is very precise, but for a successful outcome and a predictable end result, backward planning is essen- tial, since it allows the implants’ alignment in the arch, A 67-year-old female patient was referred to our de- partment for implant rehabilitation. She was generally healthy, totally edentulous in the upper jaw and par- tially edentulous in the lower jaw. The initial clinical ex- amination and the CBCT scan showed a very extensive vertical and horizontal bone defect in regions #34–37 17 1 2018