CATEGORY AUSTRALASIAN DENTIST97 CLINICAL Fig 35 Fig 38 Fig 41 Fig 44 Fig 36 Fig 39 Fig 42 Fig 45 Fig 37 Fig 40 Fig 43 Fig 46 screw-retained bridge over implants in the upper jaw and bridge in the lower jaw. Surgical procedure One hour before surgery, the patient was given two grams of amoxicillin and her mouth was rinsed with 0.12% chlorhexidine. The surgical guide template was positioned and checked for proper fit in the patient’s mouth. Infiltration anesthesia was administered via the sleeves of the lateral pins. Osteotomies were prepared, and the lateral pins were inserted one by one, beginning with the central pin. The template’s stability was subsequently confirmed (Figs. 23,24). Additional anesthesia was administered on both the facial and palatal sides. A trapezoidal mucoperiosteal flap, which involved a horizontal incision with two vertical relieving incisions at the medial and distal aspects, was released, and the guide was then secured using lateral pins (Figs. 25-27). Osteotomies were prepared according to the surgical protocol using a handpiece with saline irrigation. Osteotomies were performed, ensuring proper alignment, avoiding drill deviation, and maximizing the surface contact between the implant and bone. By creating a flat and even bone surface, the procedure enhanced the stability and integration of the implants. Initially, a 2.2 mm diameter drill was used to prepare the implant bed, and subsequent steps followed the manufacturer’s recommended insertion protocol (Figs. 28,29). In accordance with the pre-established prosthetic plan, Straumann® BLT implants (Roxolid®, SLA®) were carefully positioned using a guided implant driver, guaranteeing exact alignment as defined in the prosthetic plan. Each implant was secured with a torque of 35 Ncm (Figs. 30,31). The Loxim™ Transfer Piece was used as an alignment pin to indicate the implant position and angulation for correct parallel placement of the neighboring implants (Fig. 32). Once the position was confirmed, the transfers were released by hand. All implants achieved good initial stability, as confirmed by Ostell readings. Next, the coronal bone was reduced using bone profilers, which gradually remove excess bone surrounding the coronal part of the implant, ensuring that the prosthetic components can be properly seated. Bone profilers were placed along with a guiding pin, which helped avoid contact between any prosthetic components and bone. Straumann® Screwretained abutments (SRA) were tightened
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