Gap Magazine Implant Dentistry Today No 17

Implant Dentistry Today 19 afterwards a small flap was performed just in the regions where we expected implant exposure. The surgical guide fitted perfectly to the mucosa (Fig. 7), that was scanned with a lab’s scan and it was fixed with fixation’s pins. The site preparation with the Velo Drill ran smoothly and the sites were under prepared in order to achieve an appropriate primary stability in soft bone conditions. (Fig 10-13). The six implants were placed with the rachet and the Straumann Surgical torque control® which primary stability could be measured above 35Ncm allowing the implants to be loaded immediately (Fig 15-17). After the implant placement, a small flap was elevated in the regions with pre planned implant exposure. The Screw- retained Abutments were screwed onto the implants (Fig 18). Over the exposed implant surface (Fig 19), we performed a Guided Bone Regeneration utilizing the Professor Buser concept with the first layer in contact with the implant to be with autogenous bone chips (Fig 20). Over the autogenous bone we augmented the volume with a layer of biomaterial (cerabone®) and covered with a collagen membrane (Jason®) (Fig 21-23). The provisional copings were screwed on the top of the abutments and after the suture we started to capture the provisional copings into the prosthesis. PROSTHETIC PROCEDURE The provisional prosthesis was produced prior to the surgery, based on the wax up (Fig 25-28) and implant planning made on the Codiagnostix. Six small holes were created in the printed models, based on the surgical guide (Fig 30-31). Following the same orientation, six holes were opened in the provisional prosthesis (Fig 33). After the suture, we inserted the prosthesis in the patient’s mouth and over the implants to capture the final implant positions. With flowable composite, we connected the provisional prosthesis with the provisional titanium copings (Fig 35- 36). The final adaptation was performed chairside and after some minutes the restoration was screwed onto the Screw retained Abutments. After 3 months the temporary restoration was replaced by the final restoration. (Fig 37-44). TREATMENT OUTCOME The immediate loading in edentulous patients is a well-documented procedure with similar implant and restoration survival rates to conventional loading. The possibility to perform small adaptations in the provisional restoration that was produced before the surgery is a very good alternative in order to compensate small deviations that can occur following the guided surgery. n Fig 36: Provisional screwed rehabilitation Fig 38: Metal framework on the top of 6 BLX implants Fig 40: Rehabilitation without cantilevers Fig 42: Occlusal view of the rehabilitation Fig 44: Occlusion of the final rehabilitation. Fig 37: 3 months of healing Fig 39: Final rehabilitation Fig 41: Rehabilitation screwed on the top of the implants Fig 43: Final smile