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cerecdoctors.com
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quarter 4
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2013
onto the implants in sites #22 and #27,
removed theoldLocatorhousings fromthe
patient’smandibular denture, and attached
this denture to the Locator abutments in
sites #22 and #27 via new Locator hous-
ings via a chairside hard-acrylic pick-up.
Thefinal restorative treatment consistedof
the fabrication of a new, maxillary conven-
tional full denture, and a new, mandibular
implant-supported overdenture.
Conclusion
One can argue that the cases presented
abovecanbe treatedpredictablywithnon-
guided implant placement, thereby saving
thepatient andclinician the increasedcost
and time typically associated with guided
surgery. However, it has to be noted that
accuracy is especially important in these
types of fully edentulous caseswith severe
alveolar ridge atrophy, due to the pres-
ence of vital anatomical structures and
significantly reduced bone volume. In
addition, guided surgery typically leads to
decreased postoperative discomfort and
swelling for the patient by reducing the
need for larger flaps and bone grafts.
The bone-supported and mini-implant-
supported guides both have their own
advantages and disadvantages. However,
inmy experience, both of these techniques
have proven to be more accurate when
compared to soft-tissue-supported guides,
especially in the fully edentulousmandible.
The main problem with soft-tissue-
supported guides is either the difficulty in
ensuring that the surgical guide is seated in
the exact same position as the radiographic
template was seated during the CT scan;
or the difficulty in verifying the accuracy
of the software threshold feature utilized
with the dual-scan technique.
As with any guided surgery technique, it
| | |
B o lt c h i
Fig. 25: SiCat surgical guide attached to
mini-implants
Fig. 26: Guided implant placement in
sites #22 and #27
Fig. 27: Implant angulation verified after
removal of surgical guide
Fig. 28: Suturing of flaps
Fig. 29: Healing after two months
Fig. 30: Surgical guide inserted to localize
implant in site #27
Fig. 31: Uncovering of implant #27 and
removal of mini-implants by reverse
torqueing
Fig. 32: Clinical situation after removal
of mini-implants
25
26
27
28
29
30
31
32
isimportanttoverifythecorrectseatingand
accuracy of the surgical guide throughout
the procedure and to not blindly follow the
guide. This is especially important in these
types of fully edentulous cases with severe
alveolar ridge atrophy.
For questions and more information,
Dr. Boltchi can be reached at
.
