M. Frascaria*, M.Giannoni, M. Baldi, A. Barile**, M. D’Amario
University of L’Aquila, Department of Surgical Sciences, Odontostomatological Clinic
** Department of Radiodiagnostic
Abstract:
The aim of this study was to evaluate the clinical application of a “one-stage” surgical procedure with conical seal design implants, by using individual surgical guides for transferring planned implant trajectories directly on patient’s maxilla without flap elevation. Flap-less placement of fixtures with one-stage technique presents a number of clinical advantages but demands a careful three-dimensional evaluation of selected surgical site to avoid invasions, lesions and/or perforations of anatomical structures. The proposed procedure is finalised to the development of a simplified clinical method (semi-active system) allowing the dentist to place implants in predetermined positions and at the same time to reduce treatment invasivity (Flapless Surgery). These guides are realised through an original protocol devised by the Authors. Computerized tomographic scans elaborated by tc-interactive software (Implant3D, Media Lab Software - La Spezia, Italy), in association with radiographic devices, were used. Morpho-volumetric evaluation of selected implant sites has been carried out through the realisation of a diagnostic set-up, from which a radiographic template has been obtained. Prosthetic and spatial information, necessary to the successive phase of computerised virtual planning, were incorporated on TAC exam.
Then, the predetermined implant trajectorieshave been transferred in laboratory, directly on patient’s maxilla model, through a drilling machine with adjustable plan. The individual surgical guides obtained have been supplied with cylinders guide of 6mm of height and 2mm of inner diameter. In this way, the first osteothomical drill is addressed during surgery in the predetermined position, in accordance with "report-drill" data. 31 patients, partially and totally edentulous (13 M and 18 F), raging in age from 23 to 84 years, in good systemic health conditions, for a total of 72 Astra Tech implants (43 on mandible and 29 on maxilla), were treated.
Every patient has been subject to clinical and radiographic follow-up controls for 24 months after surgery. After a standard healing period (3-6 months), implants were subjected to prosthetic loading, with total or partial fixed prosthesis and overdenture. During this period no failures were reported, with a 100% success rate. No infection signs or significant pain and swelling symptoms were found. Moreover, every prosthesis and implant resulted stable and functional. In the within of the observation period of 24 months of this study, results clearly show the clinical reliability and the operating advantages of One-Stage Flapless Surgery technique with conical seal design implants, in association to the employment of ict-derived surgical guides.