Journal of Oral Implantology June 2012 - (Page 279)

CASE REPORT Guided Flapless Surgery With Immediate Loading for the High Narrow Ridge Without Grafting Paul A. Schnitman, DDS, MSD1,2 Sang J. Lee, DMD, MMSc2* Guillaume J. Campard, DMD, MMSc3 Maria Dona, DDS, MSD, DMSc4 Computer guided implant treatment allows implants and associated restorations to be precisely placed during the same procedure directly through the gingiva with reduced postoperative complications and surgical time. When bone height is adequate but very narrow, the virtual guided sleeve is often placed too deeply into the ridge crest interfering with the seating of the surgical template. This case report of a patient exhibiting very narrow residual ridges due to severe resorption describes a new computer guided procedure using a single surgical template maintaining bone height and immediate restoration without a mucoperiosteal flap. The success of this technique is the result of innovative modifications in the software as well as instrumentation. Modifications include planning a different implant length virtually to raise the position of guide sleeves, alteration of drilling sequences, modifications of the start drill, incorporation of osteotomes, and use of an alternative implant seating mount. The combination of these methods allows for deeper site preparation and implant seating beyond the default settings, without any crestal bone reduction. These modifications not only make the guided concept possible for the entire preparation and seating procedures, but also allow for the slight removal of bone that would interfere with the implant seating through the surgical template without a mucoperiosteal flap. This new approach to computer guided surgery maintains prosthetic precision in the fabrication of a provisional restoration prior to implantation with minimal delivery adjustments using prefabricated conical abutments when placing implants at differing levels into the high narrow ridge. Key Words: dental implant, computer-guided, stereolithographic surgical template, immediate loading, flapless, narrow ridge INTRODUCTION Private Practice, Wellesley Hills, Mass 2 Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass. 3 Private Practice, Nantes, France; Previously with Harvard School of Dental Medicine, Boston, Mass. 4 Harvard School of Dental Medicine, Boston, Mass. * Corresponding author, e-mail: sang_lee@hsdm. harvard.edu DOI: 10.1563/AAID-JOI-D-11-00215 1 C omputer-guided minimally invasive implant treatment promises to revolutionize the way we practice implant dentistry. This new technology allows implants and associated restorations to be precisely placed at the same Journal of Oral Implantology 279

Table of Contents for the Digital Edition of Journal of Oral Implantology June 2012

Editorial
Relationships Between the Gonial Angle and Mandibular Ramus Morphology in Dentate Subjects: A Panoramic Radiophotometric Study
A Comparison of Peripheral Marginal Bone Loss at Dental Implants Measured With Conventional Intraoral Film and Digitized Radiographs
Microstrains Around Standard and Mini Implants Supporting Different Bridge Designs
Surface and Biomechanical Study of Titanium Implants Modified by Laser With and Without Hydroxyapatite Coating, in Rabbits
Survival and Success Rates of Immediately and Early Loaded Implants: 12-Month Results From a Multicentric Randomized Clinical Study
Posttreatment Quantification of Patient Experiences With Full-Arch Implant Treatment Using a Modification of the OHIP-14 Questionnaire
Correlation Between Occlusal Forces and Marginal Bone Levels Around Implant- Retained Restorations: A Clinico-Radiological Study
The Influence of Maximum Bite Force on Patient Satisfaction and Quality of Life of Patients Wearing Mandibular Implant Overdentures
Guided Flapless Surgery With Immediate Loading for the High Narrow Ridge Without Grafting
Estimation of the Safe Distance Between the Implant and an Adjacent Tilted Implant Using Trigonometry
Chair-Side Fabrication of a Fixed Implant-Supported Prosthesis in an Edentulous Mandible From A Diagnostic Wax-Up: A Clinical Report
A Comparison Between Screw- and Cement-Retained Implant Prostheses. A Literature Review

Journal of Oral Implantology June 2012