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ePaper created 2018-04-10, 12:30:21 | version 1.38.0
case report | After taking the impressions in our department, the mas- ter models were made in the dental laboratory in a model tray socket and a wax set-up was produced and cus- tomised according to the aesthetic and functional evalua- tions. The patient was prepared for the computer-guided implant procedure. He underwent a CBCT with the radio- graphic template and the acquired DICOM images were processed with the aid of the CTV software. The planning with this software produced a report in which the coor- dinates of each of the three ball midpoints were deter- mined, allowing the laboratory technician to orient and reproduce the surgical template (Figs. 12a & b). The drill guides were produced via a thermoforming technique on a duplicate model of the master model. Subsequently, the drilling sleeves were incorporated with the sleeve holders in the drilling template using the additive-produced plas- tic model. The transparent base of the template enabled intraoperative assessment of the template placement on the tegument through an even ischaemia due to the contact pressure during implantation (Fig. 13). (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. After infiltration anaesthesia in the upper and lower jaw, and bilateral nerve block an- aesthesia in the lower jaw and upper palate, the surgical template was carefully inserted and stabilised correctly in the lower jaw. In the mandible, the mucosa was punched out with a rotating punch at regions #36, 34, 32, 42, 44, and 46 (Fig. 14). After disassembling the template, the gingiva points marked with the punch were cut down and the punches removed in order to obtain a punched and pre- pared lower jaw (Fig. 15). Thereafter, the drilling template was used again. According to the manufacturer’s instruc- tions, cannon drills (6 mm pilot drill; 9, 11 and 13 mm form drills) were used to prepare the implant osteotomies at regions #36, 34, 32, 42, 44 and 46 (Fig. 16). The surgical procedure was performed under local an- aesthesia with Ultracain® D-S forte 1:100,000. Cefuroxim The insertion of the implants was carried out with the standard placement head and the DRM ratchet to the maximum primary stability, at about 30–35 Ncm (Fig. 17). Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 14: Insertion of the template in the mandible. Fig. 15: Punched and prepared mandible. Fig. 16: Implant placement. Fig. 17: Manual insertion of the CAMLOG implant with the locked torque wrench. Fig. 18: All guided CAMLOG implants in the lower jaw. Fig. 19: Implantation result with all of the implants in situ. 21 1 2018