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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
case report | Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 7: Insertion of the template in the lower jaw. Fig. 8: Guided drilling through the drilling sleeve according to the surgical protocol. Fig. 9: Manual insertion of the guided implants with the locked torque wrench. Fig. 10: All guided implants in situ with gingiva formers. After bone volume analysis, implants were planned on the lingual aspect, and the implant platform virtually po- sitioned at the level of the coronal part of the vestibular alveolar crest (Fig. 4). The main feature in the produc- tion of the surgical guide was the secure positioning and stable fixation of the drilling sleeves in the template. For the production of the drilling template, the drilling sleeves were placed on the plastic models produced by an addi- tive process (Fig. 5). The surgical procedure was performed under local an- aesthesia with Ultracain® D-S forte 1:100,000. Cefuroxim (500 mg) antibiotics were given one hour before surgery and twice a day for six days thereafter. The patient rinsed with chlorhexidine gluconate (0.2 %) for one minute before the intervention (Fig. 6). The surgical template was placed intraorally in the correct position and in relation to the opposing arch. Considerable care was taken when placing the surgical template (Fig. 7). After correct placement and stabilisa- tion of the surgical template, flapless implant surgery was performed in accordance with the drilling protocol for the type of implant used (Fig. 8). At the regions #34 and 44, two CAMLOG fully guided implants of 4.3 mm in diame- ter and 13.0 mm in length were inserted, and in regions #36 and 46 implants of 4.3 mm in diameter and 11.0 mm in length. Moreover, two small full-thickness flaps were raised in order to remove the osteosynthesis screws used to stabilise the autogenous bone graft in the previous augmentation surgery (Fig. 9). The insertion of the im- plants was carried out with the standard placement head and the DRM ratchet to the maximum primary stabil- ity, with a preset insertion torque of 35–45 Ncm. The gingiva formers were inserted to a torque of 20 Ncm (Fig. 10) and the flaps were sutured after the implant in- sertion with non-resorbable sutures (Prolene 5/0). The sutures were removed after seven days. A postoperative 19 1 2018