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By-pass of the inferior alveolar nerve with the aid of dynamic computer surgery
EAO Online Library. Pelagalli P. Oct 9, 2018; 232778
Pierluigi Pelagalli
Pierluigi Pelagalli
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In this case report we present a by-pass of the inferior alveolar nerve in a situation of vertical bone deficiency. A dynamic guided computer surgery system has been used to plan and realize the surgery.The implant has been inserted freehand,without the aid of a surgical template,and its final position corresponds to the programmed one keeping the correct distance from the NAI and respecting a correct prosthetic axis. The system has been accurate and allowed us to work safely.The aim of this case report is to show a clinical situation in which the dynamic computer aided surgery allow us to overcome anatomical limits and respect the prosthetic plan in a controlled and predictable way.57-year-old male patient comes to our observation after the loss of an implant (36). The patient reports having inserted,5 years before, short implants in zone 36 and 37. At the clinical examination, the patient presents an edentulous area (36) with a reduction of the keratinized tissue and an horizontal and vertical bone volume resorption (class 3 of Seibert or class D Pelagalli). The measurements taken on the CBCT examination indicate a thickness of about 6mm, while in the vertical direction the distance from the top of the ridge to the mandibular canal is 5 mm. From the same examination, however, the possibility of inserting a standard 3.8mm diameter implant laterally to the mandibular canal is appreciated.Once the implant planning is completed,with the Navident (Claro Nav inc. ) software, the surgical part is carried out.A partial thickness flap was realized to improve soft tissue's volume and the implant was inserted following the direction showed on the Navident display.The final position of the implant corresponds to the programmed one keeping the correct distance from the NAI and respecting a correct prosthetic axis. The healing of the soft tissue showed an increase of keratinized tissue on the buccal side of the implant. After 3 months a ceramic crown was realized. The system proved to be accurate and reliable and allowed us to solve a difficult anatomical condition in total safety.The use of the dynamic guided surgery allow us to solve a case that wouldn't have been possible to realize freehand. The absence of the template allow us to work in posterior sector,where the mouth's opening is limited, and to manage the soft tissue with greater freedom.Moreover the planning of the implant has been realized respecting the prosthetic design.
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