Author: Prof. Dr. Augusto Bessa

Introduction

The guided surgery technique is an option that, besides adding value to your services, also allows for more precise and less invasive surgeries. Since the introduction of the guided technique, many adversities have been overcome and, with the advancement of the technique and of new technologies, it has never been so simple and accessible to offer this type of treatment to the patient. I will share with you the report that follows in which I was able to achieve a very interesting result in the installation of the implant and the prosthesis, as well as patient’s satisfaction in the post-operative phase.

 

Case Report

The patient, Mr. M.A.P.S., came to our private clinic needing oral rehabilitation for element 15. Clinically, the element had a fractured crown in the palatine region and, the image exam, showed an extensive bone dehiscence in the vestibular plate and a periapical lesion (Figure 1).

Figure 1: compromised vestibular bone plate in element 15.

The removal of the element in question was carried out and the bone alveolar ridge preservation was performed using the bone substitute Nanosynt, associated to platelet rich fibrin (PRF), through the protocol PRF BLOCK (Figure 2).

Figure 2: PRF BLOCK carried out with the bone substitute Nanosynt.

Six months later, a new CT-scan was requested and a new radiopaque image suggesting new bone formation was noted in the region (Figure 3).

                                                                                                                    Figure 3: image suggesting the new bone formation in the region of element 15.

The DICOM and STL files belonging to the patient were sent to the Planning Center (Figure 4) for the manufacture of a prototyped surgical guide (Figure 5) for the Arcsys Guided Surgery (AGS).

Figura 4: Arcsys Guided Surgery Planning. Note that the FGM implants are available from the 3SHAPE library.

Figure 5: Prototype Surgical Guide

The present literature describes some important advantages for the realization of the Guided Surgery: possibility to operate the patient without incisions and detachment of fibro-mucosae, decreasing bleeding, providing more comfort and correct tridimensional positioning of the implants and optimizing the prosthetic results.

And, specifically about the Arcsys Guided Surgery System, we can also mention other advantages such as: possibility to compensate using just one driver; possibility to use short implants and Small AGS drills.

The guided surgery was carried out and the minimum trauma and conservationism is noticeable in this type of surgery (Figure 6).

Figure 6: Minimum trauma in the guided surgery.

During the planning, it was noted that for the congruence of the bone quality/quantity with the prosthetic solution, the angulation of 8 degrees for the prosthetic component was going to be an important factor for the prosthetic longevity. It is possible to note that possibility for customization of the angulation between 0 and 20 degrees in the prosthetic components of the FGM Arcsys System (Figure 7) and, since a high torque was obtained, the planned prosthetic component was immediately installed (figure 8).

Figure 7: possibility for customization of the angulation between 0 and 20 degrees in the prosthetic components of the FGM Arcsys System.

Figure 8: planned prosthetic component installed

Three months later, waiting for osteointegration, the prosthetic step was carried out and the case was finalized (Figure 9). Presently, the case is at its 28-month follow up with the observation of bone formation around the prosthetic component (Figure 10).

Figure 9: free metal crown made over the implant in element 15.

Figure 10: 28-month follow up, noting the bone formation around the prosthetic component

 

References

1. FGM Product Catalog – Arcsys Guided Surgery https://www.fgm.ind.br/en/arcsys-guided-surgery/
2. Regeneração Óssea Guiada na Implantodontia. Daniel Buser – Quintessence Editora – 2010
3. Aumento Vertical e Horizontal do Rebordo – Novas Perspectivas. Istvan Urban – Quintessence Editora – 2017
4. Regeneração Guiada Tecidual. Mauro Cruz – Editora Santos – 2006
5. Enxertos ósseos em Implantodontia. Jean-François Tulasne e Andreáni – Quintessence Editora – 2010
6. Enxertos Ósseos em Implantodontia. Reanato Mazzonetto et al. – Napoleão Editora – 2012
7. Transplantes Ósseos na Implantodontia. André Antonio Pelegrine et al. – Napoleão Editora – 2008
8. FGM Product Catalog https://www.fgm.ind.br/en/products/bone-nanosynt-replacement/
9. Choukroun, J. (2001) Une opportunit_e en paroimplantologie: le PRF. Implantodontie, 42, 55– 62. French.
10. Dohan, D. M., Choukroun, J., Diss, A., Dohan, S. L., Dohan, A. J., Mouhyi, J. & Gigly, B. Platelet-rich fibrin (PRF): a second generation platelet concentrate. Part I: Technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: E37–44.
11. Pan J, Xu Q, Hou J, Wu Y, Liu Y, Li R, Pan Y, Zhang D. Effect of platelet-rich fibrin on alveolar ridge preservation: A systematic review. J Am Dent Assoc 2019; 150: 766-78. doi: 10.1016/j.adaj.2019.04.025.
12. FGM Product Catalog – Arcsys Guided Surgery https://www.fgm.ind.br/en/arcsys-guided-surgery/