PMC8298149_01
Preoperative intraoral status.
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She complained of occasional dry mouth and inflamed gums, which is a typical oral manifestation of this disease (Figure 1).
Preoperative panoramic image.
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An X-ray of the jaw (digital panoramic image) revealed that teeth 14, 24, and 27 needed to be extracted or undergo root canal treatment (Figure 2).
3D planning:transcanine approach in regions 13 and 23.
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The implant positions were digitally planned considering the final prosthodontic solution (position of the future abutments and crowns) as well as the position of the impacted canines (i.e., avoiding hard canine enamel that could impair the drilling; Figure 3).
Surgical guide.
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The guide was then 3D printed with a Straumann P20+3D printer (Rapid Shape, Heimsheim, Germany) using Pro Surgical Guide clear transparent resin material (P Pro Resin, DeltaMed, Friedberg, Germany; Figure 4).
Osteotomy using a pilot drill and a surgical guide.
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Therefore, we decided to use only a "partial" guided surgical approach for regions 13 and 23 and a drill up to 2.2 mm in diameter (pilot drill) to achieve the planned position of the implants in relation to the axis of the impacted teeth, bearing in mind the need to avoid the tooth enamel (Figures 5-7).
Gradual drilling with additional saline irrigation/cooling.
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Therefore, we decided to use only a "partial" guided surgical approach for regions 13 and 23 and a drill up to 2.2 mm in diameter (pilot drill) to achieve the planned position of the implants in relation to the axis of the impacted teeth, bearing in mind the need to avoid the tooth enamel (Figures 5-7). Classic osteotomy without a surgical template was then done with final drills for implants at positions 13 and 23 (BLT SLActive Roxolid RC 4.1; Institut Straumann AG, Basel, Switzerland) with constant additional irrigation with 0.9% NaCl to ensure adequate cooling (Figure 6).
Drill hole through the bone and the impacted tooth (the white arrow).
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Therefore, we decided to use only a "partial" guided surgical approach for regions 13 and 23 and a drill up to 2.2 mm in diameter (pilot drill) to achieve the planned position of the implants in relation to the axis of the impacted teeth, bearing in mind the need to avoid the tooth enamel (Figures 5-7).
Panoramic image 3 months postop.
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Tokyo, Japan) on the natural teeth, and the implant crowns were tightened to SR abutments with 15 N/cm, as recommended by the manufacturer. Follow-up orthopantomogram was carried out at 3 and 6 months postoperatively (Figures 8-11). The patient was followed up for one year until now after the prosthodontic procedure was done.
Intraoral status; the definite prosthodontic work.
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Tokyo, Japan) on the natural teeth, and the implant crowns were tightened to SR abutments with 15 N/cm, as recommended by the manufacturer. Follow-up orthopantomogram was carried out at 3 and 6 months postoperatively (Figures 8-11). The patient was followed up for one year until now after the prosthodontic procedure was done.
Panoramic image 6 months postop.
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Tokyo, Japan) on the natural teeth, and the implant crowns were tightened to SR abutments with 15 N/cm, as recommended by the manufacturer. Follow-up orthopantomogram was carried out at 3 and 6 months postoperatively (Figures 8-11). The patient was followed up for one year until now after the prosthodontic procedure was done.
Patient's smile.
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Tokyo, Japan) on the natural teeth, and the implant crowns were tightened to SR abutments with 15 N/cm, as recommended by the manufacturer. Follow-up orthopantomogram was carried out at 3 and 6 months postoperatively (Figures 8-11). The patient was followed up for one year until now after the prosthodontic procedure was done.