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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
| case report Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 3: Sagittal section in region #46 of the planned implantation. Fig. 4: Virtual dental panoramic tomogram with the digitally determined 3-D implant positions. Fig. 5: Fully navigated drilling template for the lower jaw after CBCT planning. Fig. 6: Preoperative view of the mandible. and 44–47 as consequence of progressive resorption. After the final diagnosis and planning, we discussed the possible restorative options and alternative solutions. The patient was not satisfied with her removable denture in the lower jaw and wished for a fixed denture. In order to make treatment possible with bridge con- structions on osseointegrated titanium fixtures, bone grafting was necessary in the edentulous regions of the lower jaw. The patient was explicitly informed of the pos- sible risks and dangers from the functional and aesthetic perspective during and after the treatment period and the treatment steps were explained. Five months after the reconstruction of the alveolar jaw with iliac crest bone (Fig. 2), we were able to continue our therapy planning, which included preoperative prosthetic planning and navigated implantation. After taking impressions, a wax set-up was produced. The aesthetic set-up in wax served for the shape speci- fication for the preparation of the provisional restoration, the final restoration and the implant planning. The vir- tual planning followed. The radiographic template for CBCT imaging was prepared on a duplicate of the master model with light-curing tray material. Three radiographic balls made of aluminium were inserted into the radiographic template (Fig. 1). The use of the three balls increased the precision of the planning, because in this procedure, the ball midpoints and not edges were adjusted. A CBCT scan was performed with the patient wearing the radiographic guide. The basis for the implant planning was the data set obtained from the CBCT scan. The minimally invasive, transgingival implantation was planned using the 3-D data set with the CTV software. Anatomical conditions had to allow the placement of at least four implants in the ideal position for prosthetic re- habilitation (Fig. 3). Once an implant had been planned, it was easy to see the vestibular and lingual cortical bone. 18 1 2018