PMC3745845_01
Preoperative panoramic radiograph.
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Preliminary radiographic screening was performed using panoramic orthopantomographs (Figure 1).
Virtual implant planning. Occlusal view.
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CT scans were performed: one with the patient wearing the radiographic guide as well as the radiographic index, the other with the radiological template alone. CT scan data were transferred to the software program for 3D diagnostic analysis and virtual implant planning (Figure 2).
Guided flapless implant insertion in healed sites and fresh extraction sockets.
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After correct placement and stabilization of the surgical template, flapless implant surgery was performed in accordance with the drilling protocol for the type of implant used (Figure 3) (NobelReplace Tapered Groovy, Nobel Biocare, Gothenburg, Sweden) in 16 ridges (15 maxillas, 1 mandible), while in 7 mandibular cases, a small full-thickness flap was raised in order to preserve keratinized tissue.
Immediate loading with screw-retained temporary prosthesis.
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117 out of 120 implants were immediately loaded with the prefabricated screw-retained provisional prosthesis (Figures 4 and 5), while three remaining implants placed with an insertion torque less than 35 Ncm were delayed loaded.
Panoramic radiograph after immediate loading.
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117 out of 120 implants were immediately loaded with the prefabricated screw-retained provisional prosthesis (Figures 4 and 5), while three remaining implants placed with an insertion torque less than 35 Ncm were delayed loaded.
Final restoration with zirconia ceramic screw-retained prosthesis.
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The definitive prosthetic restorations, either Procera implant bridge titanium as the framework and resin as aesthetic material (18 ridges) or Procera implant bridge zirconia ceramic (5 ridges) were then inserted (Figures 6 and 7).
Panoramic radiograph 30 months after loading.
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The definitive prosthetic restorations, either Procera implant bridge titanium as the framework and resin as aesthetic material (18 ridges) or Procera implant bridge zirconia ceramic (5 ridges) were then inserted (Figures 6 and 7).