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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
| case report dental panoramic tomogram showed the inserted im- plants in the lower jaw and the areas of augmentation on both sides were also clearly recognisable (Fig. 11). After the operation, the patient was instructed to cool and protect the operating area; a chlorhexidine gluco- nate mouthwash (0.2 %) was prescribed for one minute twice a day for two weeks after surgery and painkillers, if necessary. The patient was instructed on oral hygiene. Scheduled visits after surgery were after one week, two weeks and one month. At these visits, the healing process was found to be very good and painless. The de- finitive prosthetic restoration was planned for four months after the implantation. Case 2 A 75-year-old male patient was referred to our depart- ment for dental examination and for implant rehabilita- tion. In 2011, he had been diagnosed with squamous cell carcinoma on the right side of the tonsil. After the tumour resection and neck dissection and an adjuvant radiation therapy of up to 65 Gy, the patient was in the ambula- tory tumour follow-up phase of care. This was the case because the tumour resection was inconspicuous and without signs of recurrence. Through the previous tumour surgery, the anatomy of the oral cavity had changed fun- damentally: owing to xerostomia and radiation-induced caries in 2013, all of the remaining teeth in both jaws had had to be extracted. The first clinical examination in our department found a totally edentulous upper and lower jaw with a loss of taste and xerostomia. The dental panoramic radio- graph showed about 10 per cent vertical and 15 per cent horizontal bone loss in both dimensions in the upper and lower jaw. After the final diagnosis and plan- ning, we discussed the possible restorative options and alternative solutions. Because of the post-irradiated jaw, a purely mucosa-supported prosthesis was not in- dicated, and owing to the xerostomia, the maintenance of a purely mucosa-supported prosthesis was not guar- anteed. Therefore, the only medically reasonable and practical solution was the insertion of dental implants, six implants in the maxilla and six in the mandible, with subsequent incorporation of an implant-supported fixed denture. Fig. 11 Fig. 12a Fig. 12b Fig. 13 Fig. 11: Dental panoramic tomogram of the patient after the surgery for control of the implants’ positions. Figs. 12a & b: Virtual dental panoramic tomogram showing the digitally determined 3-D implant positions in the maxilla (a) and in the lower jaw (b). Fig. 13: Fully navigated drilling templates after CBCT planning (drilling sleeves, fully guided 4.3 mm, violet). 20 1 2018