Case study
Fig 4
Fig 5
Fig 6 REFERENCES Fig 7 Fig 8 Continued »
Due to the extent of bone loss we had to angle the implants, ensuring a minimum clear- ance from the mental foramen on the RHS7, and ensure not to compromise the adjacent teeth. The CBCT also allowed for measurement of the Houns- field units to allow an accurate analysis of the of the bone density to allow for optimum placement.
Procedure A tooth borne stereolitho- graphic stent fitted with Expertease guide rings was constructed by Materialise Dentsply Belgium. The patient was sedated using IV Mida- zolam and local anaesthesia was delivered. Figure four shows the stent
being seated and the osteotomy sequence being completed transmucosally as described by Dentsply (Figure 5). Healing abutments were placed at the time of surgery (Figure 6) and new temporary denture seated clear of the surgical site. Healing was uneventful and the patient reported very minor post-operative discomfort, a common feature of flapless surgery8. The use of a flapless tech-
nique also is shown to improve the tissue profile and mucosal form around the implant9. The
implants were restored after a period of osseointegration of approximately ı2 weeks conforming to recommended clinical proceduresı0. Standard titanium abutments were placed and torqued to 25Ncm-ı, (Figure 7) and a precious metal bonded to ceramic bridge was constructed and cemented in place. Figure 8 shows the final prosthesis in situ.
ABOUT THE AUTHORS
Dr Eilert Eilertsen BDS, (top) is the practice owner of Eilertsen Dental Care in Inverness. The practice is an entirely private operation that offers both general dentistry and implan- tology (including referrals). Dr Eilertsen has over 20 years’ experience in the field of Implantology.
Dr Mark Skinner BDS, MFDS RCS Ed, PG Dip (Implan- tology) (above) is the senior associate at Eilertsen Dental Care. Dr Skinner has worked alongside Dr Eilertsen for over two years is also available for implant referral.
Outcomes/maintenance After a month, the patient was reviewed. She reports a vast improvement in her quality of life, masticatory function and aesthetics. She has been organ- ised for 3/ı2 recall with the dental hygienist for continua- tion of her maintenance regime.
Personal reflection The advances in software and scanners available today offer clinicians unprecedented accuracyıı-ı3, atraumatic tech- nique and a reduced likelihood of post-operative complica- tions8, ı4. This case demonstrates the use of the latest Sirona CBCT, Simplant Software and Ankylos Expertease Surgical kit. Now, within ı0 days, a virtu-
ally designed stent is manufactured and delivered with the planning all done before the patient arrives for surgery thereby making an otherwise complex procedure relatively straightforward.
1. Tan, K., et al., A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res, 2004. 15(6): p. 654-66. 2. Jung, R.E., et al., A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res, 2008. 19(2): p. 119-30. 3. Chiapasco, M., M. Zaniboni, and M. Boisco, Augmentation procedures for the rehabilitation of deficient edentu- lous ridges with oral implants. Clin Oral Implants Res, 2006. 17 Suppl 2: p. 136-59. 4. Palmer, W., A. Crawford-Sykes, and R.E. Rose, Donor site morbidity following iliac crest bone graft. West Indian Med J, 2008. 57(5): p. 490-2. 5. Zins, J.E. and L.A. Whitaker, Membra- nous versus endochondral bone: implica- tions for craniofacial reconstruction. Plast Reconstr Surg, 1983. 72(6): p. 778-85. 6. Clavero, J. and S. Lundgren, Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: comparison of donor site morbidity and complications. Clin Implant Dent Relat Res, 2003. 5(3): p. 154-60. 7. Juodzbalys, G., et al., Inferior alveolar nerve injury associated with implant surgery. Clin Oral Implants Res, 2013. 24(2): p. 183-90. 8. Fortin, T., et al., Effect of flapless surgery on pain experienced in implant placement using an image-guided system. Int J Oral Maxillofac Implants, 2006. 21(2): p. 298-304. 9. Lee, D.H., et al., Effects of flapless implant surgery on soft tissue profiles: a prospective clinical study. Clin Implant Dent Relat Res, 2011. 13(4): p. 324-9. 10. Cochran, D.L., D. Morton, and H.P. Weber, Consensus statements and recommended clinical procedures regarding loading protocols for endos- seous dental implants. Int J Oral Maxil- lofac Implants, 2004. 19 Suppl: p. 109-13. 11. Widmann, G. and R.J. Bale, Accuracy in computer-aided implant surgery--a review. Int J Oral Maxillofac Implants, 2006. 21(2): p. 305-13. 12. Jung, R.E., et al., Computer technology applications in surgical implant dentistry: a systematic review. Int J Oral Maxillofac Implants, 2009. 24 Suppl: p. 92-109. 13. Nickenig, H.J., et al., Evaluation of the difference in accuracy between implant placement by virtual planning data and surgical guide templates versus the conventional free-hand method - a combined in vivo - in vitro technique using cone-beam CT (Part II). J Cranio- maxillofac Surg, 2010. 38(7): p. 488-93. 14. Rousseau, P., Flapless and tradi- tional dental implant surgery: an open, retrospective comparative study. J Oral Maxillofac Surg, 2010. 68(9): p. 2299-306.
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