Scientifica implantology

Numeri Uno 22; 2015, 21-25

Numeri Uno, 06; 2015, 16-21

Quintessenza Implantologia 2016, 3

Quintessenza Implantologia 2016, 3

In this series of clinical cases, computer-aided planning of the implant insertion allowed the avoidance reconstructive surgery, taking advantage of the remaining bone. Implant positionioning was congruent with the planning and the implants were immediately loaded after surgery with a temporary prosthesis prepared in advance thanks to digital planning.

NumeriUno, 8, 04-05, 2009

In this clinical case, the single-model technique allowed rehabilitating the patient with one surgery and a minimal number of sessions for finalising the screwed prosthesis, obtained with the CAD-CAM Echo protocol on Kohno implants.

Numeri Uno, 2015; 04: 16-19

GUIDED SURGERY WITH IMMEDIATE LOADING: IS IT A PREDICTABLE TECHNIQUE? A CLINICAL CASE

Male edentulous patient aged 35 years, classification ASA type I, for maxilla rehabilitation with 8 Outlink2 implants with external connection (Sweden & Marina), using guided surgery with bone support and immediate loading. Simplant® software was used for the treatment plan and the production of a stereolithographed surgical guide.
A photographic study was made, including extra-oral photographs for the median facial line, parallelism between the bipupillary line and the intercommissural line, analysis of the facial thirds, type of profile and vertical dimension.
The preliminary impressions were taken with irreversible hydrocolloids (aligned) to obtain master study models. The facial arch and the intermaxillary registers were determined, for mounting in the articulator.
The basic structure was prepared with wax, then carrying out a trial of the teeth for the fixed prosthesis, on which the radiological-surgical guide would be based.
A CAT scan was made with a duplicate guide in the patient’s mouth. A preliminary study was then made by computer for the ideal position of the prosthesis on the dental implants.
This transfer of the position of the implants stabilized in the pre-surgical phase made it possible to develop the prosthesis for immediate loading in advance.
After assessing the clinical conditions of the study, the type of surgical guide most suitable for the patient was chosen, on the basis of bone support.

The radiographic study was used:

• To make the CAT scan after occlusion was tested with the duplicate of the radiographic guide, as explained earlier.
• To reconstruct the CAT scan images using the specific software for this surgical procedure.
• To determine the ideal site for the positioning of the implants according to the available bone, the final prosthesis and the anatomical structures.

The patient presented at our surgery after the study had been completed using the software, with both the radiographic and the clinical data. All information was sent to the technical centre for preparation and return of the surgical guide before surgery.
A total-thickness flap was first raised, fixing the stereolithographed surgical guide with two lateral pins and with surgical implants in each arch. A posterior milling protocol was performed through the guide, which was oriented on the inclination/angle of the alveolus.
The immediate prosthesis was then produced. The immediate prosthesis was adapted in the same surgical phase with an acrylic eggshell temporary, which had been made previously in the articulator above the temporary anti-rotation posts, according to the position of the planned implants.
The acrylic temporary had perforations for the exits of the fixation screws of the temporary posts, to avoid escape of the self-polymerizing acrylic during relining, and to obtain a fixed but removable prosthesis. After hardening, excess material was removed from the model. Finally, it was screwed onto the posts again and sealed with cotton and acrylic.

The use of guided stereolithographed surgical guides represent a step forward in oral implantology. With meticulous planning and appropriate software, predictable results can be obtained due to the study performed, but at a more expensive cost than with conventional methods.
The technique described requires long-term research and improvements to the fixing points for ferrules.

Numeri Uno, 2013;16:12-13

ECHOPLAN: ACCURACY OF GUIDED IMPLANTOLOGY

Guided implantology offers a new method of performing surgical operations based on planning.
Software applications process DICOM images from the cone beam, giving a 3D rendering in which the implant can be inserted virtually. The production of a surgical guide makes it possible to transfer project information for the operation, which thanks to the engineering of the Sweden & Martina EchoPlan kit becomes easier to perform for the implantologist, with greater comfort for the patient and greater insertion precision. Guided implantology is the door that gives access to new methods for planning implantology and prostheses. Digital techniques reduce time and costs, and increases predictability and the coherence between theory and practice.
Case discussion: the operation was carried out by cutting a small flap, requiring only a single application of anaesthetic, and was completed very quickly thanks to the use of a Safe surgical guide (Materialise) and EchoPlan surgical kit (Sweden & Martina). A downsizing technique was used for the implant site, due to poor bone density (3/4 ratio). An assessment analysis between the virtual project and actual execution showed a substantial superimposition and level of precision of the guided implantology system used.

Implantology of the second millennium not only sets itself the goal of osseointegration and maintenance of the implant over time with consequent health of the
hard and soft tissues, but also of guaranteeing restoration of the function, safe and minimally invasive surgery, maintenance, improvement of the aesthetics and, last but not least, short treatment and rehabilitation times.
In this context, software-assisted surgical techniques are the ideal solution for meeting all the requirements of modern implantology, allowing a detailed pre-operative analysis of the clinical case with the use of evolved instruments such as TC and dedicated software. It guarantees high precision surgical performance, thanks to the use of guides that allow inserting and positioning of the implants in the designed position; ensuring fi nally the possibility of pre-fabricating a prosthesis applicable to the patient already at the end of the surgical phase, in the presence of adeguate conditions. By applying to software-assisted surgery the “golden rules” that use a “free hand” in implantology, clinicians, therefore, have at their disposal an extraordinary technique for placing implants with great precision, via in-depth analysis, and with greater
comfort for their patients.

Numeri Uno, 2013; 16:16-18

BILATERAL REHABILITATION WITH GUIDED SURGERY

Patient: C.D.
Age: 31 years
Sex: female
Smoker: < 10

Negative anamnesis for pathologies or situations with contraindications for implant insertion. Complex dental anamnesis.
Amongst other procedures, it was necessary to extract element 36 located post-distally from the 34–36 bridge.
To resolve the bilateral lower rear edentulism, 4 Premium implants (Sweden & Martina) were planned with immediate loading, with 36 being inserted immediately post-extraction.
For details on the dimensions of the implants and their positions, see chart 1.
Flapless surgery was performed with a Surgiguide guide (Materialise) with dental and gingival support, and Echo Plan (Sweden & Martina) surgical kit, following the sequence indicated by the surgical manual.
The temporary crowns for immediate loading were made pre-operatively on an Immediate Smile model and passivated with intraoral gluing.

Il dentista moderno, 2012; Marzo: 86-102

ASSESSMENT OF A CLINICAL AND TECHNICAL PROCEDURE FOR THE REHABILITATION OF EDENTULOUS JAWS

This series of clinical cases with Premium implants, inserted with a protocol of guided surgery (ECHOPLAN) and rehabilitated with temporary immediate loading using the SIMPLE technique, and subsequently definitively with Toronto Echo made using CAD/CAM methods, validated the quality and replicability of the entire clinical procedure based on a digital approach.