Comparative Evaluation of Implants with Different Surface Treatments Placed in Human Edentulous Mandibles: A 1-Year Prospective Study.

The aims of this study were to analyze prospectively and comparatively the peri-implant bone crest levels, bone density, stability and success rate of implants with different surface treatments in human edentulous mandibles. Twenty edentulous patients were selected. Four different implants were placed between the mental foramen. Four groups were evaluated: (1) laser-modified surface (LASER), (2) surface modified by laser with deposition of apatites (LASER + HA), (3) surface modified by double acid etching (ACID, Implacil De Bortoli) and (4) surface modified by sandblasting and acid etching (SLActive®, Straumann). Clinical, radiographic, resonance frequency and tomographic analyses were used. After 4 months, mandibular fixed implant prostheses were installed. Clinical and radiographic analyses were performed at times T0 (immediately after implant placement), T1 (15 days), T2 (30 days), T3 (60 days), T4 (90 days), T5 (120 days), T6 (180 days) and T7 (360 days), post-implant placement. The resonance frequency analysis (RFA) was measured at T0, T4, T6 and T7. The tomographic analysis was performed at T0, T4 and T7. In the radiographic bone density analysis, a statistical difference was found between the SLActive® and LASER + HA groups at T4 (p < 0.05). Statistical differences were observed in RFA at T4 (90 days), between the SLActive® and LASER groups (p < 0.05) and between the SLActive® and LASER + HA groups (p < 0.05). At T6 and T7, statistical differences were found between the SLActive® group and all other implant surfaces (p < 0.01). The experimental surfaces analyzed showed encouraging positive outcomes compared to those of the SLActive® surface. Long-term follow-up should be performed to confirm these results.

Evaluation of Short and Regular Implants after Prosthesis Placement in the Mandible: A Nonrandomized Controlled Clinical Trial.

AIM: The aim of this nonrandomized controlled preliminary clinical trial was to compare treatment using short and conventional implants in the posterior region of the mandible after prosthesis installation by means of clinical, resonance frequency, and radiographic analyses. MATERIALS AND METHODS: A total of 10 patients with 40 dental implants already installed were included in this study. Four implants were installed for each subject, in which the length of the implants (short and conventional) was distributed according to the reminiscent alveolar bone in the left and right side of the mandible. All implants received splinted prosthesis after the osseointegration period. Analyses were performed immediately after prosthesis installation (T1), and 3 (T2) and 6 months (T3) after prosthesis placement. RESULTS: The 6-month survival and success rates were 100% for the short and conventional implants. Probing depths (PDs) after 6 months did not show statistical differences between short and conventional implants. All groups showed mean implant stability quotient (ISQ) values above 60 in all periods evaluated, demonstrating great implant stability, and no differences were found between groups at T3. Radiographic measurements showed an increased bone loss for conventional implants compared with short implants in all the three periods evaluated. CONCLUSION: Our findings suggest that treatment of resorbed posterior regions in the mandible with shorter dental implants is as reliable as treatment with conventional implants after 6 months of splinted prosthesis installation. CLINICAL SIGNIFICANCE: Short implants might be considered a predictable treatment alternative to bone augmentation or extensive surgical techniques in regions of restricted vertical bone height in the posterior region of the mandible.

Full-Mouth Rehabilitation Using All-Ceramic Restorations.

The scientific and technological advancement of cosmetic dentistry has improved metal-free ceramic systems for fixed prosthodontics as well as porcelain veneers, making them an excellent treatment option for delivering superior cosmetic results. The authors present a clinical case of full-mouth rehabilitation using all-ceramic restorations with porcelain metal-free unit crowns in the maxilla, and porcelain veneers from the left inferior premolar to the right inferior premolar. Using this approach, they were able to achieve an excellent esthetic and functional result for the patient.

Clinical study on survival rate of short implants placed in the posterior mandibular region: resonance frequency analysis.

OBJECTIVE: Short implants are increasingly used, but there is doubt about their performance being similar to that of regular implants. The aim of this study was to compare the mechanical stability of short implants vs. regular implants placed in the edentulous posterior mandible. MATERIAL AND METHODS: Twenty-three patients received a total of 48 short implants (5 × 5.5 mm and 5 × 7 mm) and 42 regular implants (4 × 10 mm and 4 × 11.5 mm) in the posterior mandible. Patients who received short implants had <10 mm of bone height measured from the bone crest to the outer wall of the mandibular canal. Resonance frequency analysis (RFA) was performed at time intervals T0 (immediately after implant placement), T1 (after 15 days), T2 (after 30 days), T3 (after 60 days), and T4 (after 90 days). RESULTS: The survival rate after 90 days was 87.5% for the short implants and 100% for regular implants (P < 0.05). There was no significant difference between the implants in time intervals T1, T2, T3, and T4. In T0, the RFA values of 5 × 5.5 implants were higher than values of 5 × 7 and 4 × 11.5 implants (P < 0.05). A total of six short implants that were placed in four patients were lost (three of 5 × 5.5 mm and three of 5 × 7 mm). Three lost implants started with high ISQ values, which progressively decreased. The other three lost implants started with a slightly lower ISQ value, which rose and then began to fall. CONCLUSIONS: Survival rate of short implants after 90 days was lower than that of regular implants. However, short implants may be considered a reasonable alternative for rehabilitation of severely resorbed mandibles with reduced height, to avoid performing bone reconstruction before implant placement. Patients need to be aware of the reduced survival rate compared with regular implants before implant placement to avoid disappointments.

Histometric analysis and topographic characterization of cp Ti implants with surfaces modified by laser with and without silica deposition.

Biologic behavior of the bone tissue around implants with four different surfaces was evaluated. The surfaces were: modified by laser (LS); modified by laser with sodium silicate deposition (SS); and commercially available surfaces modified by acid etching (AS) and machined surface (MS). Topographic characterization of the surfaces was performed by scanning electron microscopy (SEM)- energy dispersive X-ray spectrometry (EDX) before experimental surgery. Thirty rabbits received 60 implants in their right and left tibias, 1 implant of each surface being placed in each tibia. The analyzed periods were 4, 8, and 12 weeks postoperatively. Histometric analysis was performed evaluating bone interface contact (BIC) and bone area (BA). The results obtained were submitted to the analysis of variance and the Tukey t-test. The elemental mapping was evaluated by means of SEM at 4 weeks postoperatively. The topographic characterization showed differences between the analyzed surfaces. Generally, the BIC and BA of LS and SS implants were statistically higher than those of AS and MS in most of the analyzed periods. Elemental mapping showed high peaks of calcium and phosphorous in all groups. Based on the present methodology, it may be concluded that experimental modifications LS and SS accelerated the stages of the bone tissue repair process around the implants, providing the highest degree of osseointegration.

Rehabilitation of the maxillary arch after bone graft using immediate loading with implant-supported fixed restoration.

Moderate and controlled loading environments support or enhance osteogenesis, and, consequently, a high degree of bone-to-implant contact can be acquired. This is because when osteoprogenitor cells are exposed to limited physical deformation, their differentiation into osteoblasts is enhanced. Then, some range of microstrain is considered advantageous for bone ingrowth and osseointegration. The primary stability has been considered one of the main clinical means of controlling micromotion between the implant and the forming interfacial tissue, which helps to establish the proper mechanical environment for osteogenesis. Based on the biological aspects of immediate loading (IL), the objective of this study is to present a clinical case of maxillary arch rehabilitation using immediate loading with implant-supported fixed restoration after bone graft. Ten dental implants were placed in the maxilla 6 months after the autogenous bone graft, removed from the mandible (bilateral oblique line and chin), followed by the installation of an immediate-load fixed cross-arch implant-supported restoration because primary stability was reached for 8 implants. In addition, instructions about masticatory function and how it is related to interfacial micromotion were addressed and emphasized to the patient. The reasons for the IL were further avoidance of an interim healing phase, a potential reduction in the number of clinical interventions for the patient, and aesthetic reasons. After monitoring the rehabilitation for 8 years, the authors can conclude that maxillary IL can be performed followed by a well-established treatment planning based on computed tomography, providing immediate esthetics and function to the patient even when autogenous bone graft was previously performed in the maxilla.

Resolução simplificada pela conversão de uma prótese parcial fixa/removível de extensão distal em uma overdenture maxilar retida por implantes / A simple treatment way by conversion of a distal extension fixed/removable bridge into an implant-retained maxillary overdenture: a case report

Este trabalho relata um caso clínico onde uma paciente de 82 anos de idade queixava-se da instabilidade da porção removível de sua prótese maxilar híbrida. Dois implantes foram colocados na região posterior e a nova prótese passou a funcionar como uma overdenture retida por encaixes tipo O-ring. As extremidades distais dos encaixes nas coroas metalocerâmicas dos dentes 13 e 23 não puderam ser capturadas. Mesmo em função das limitações técnicas e econômicas, o tratamento proposto satisfez as exigências estéticas e funcionais da paciente.

This work reports a clinical case where a 82 years-old patient had complaints about the removable portion of an hybrid maxillary prosthesis. Two dental implants were inserted in the posterior region and the new reconstruction was designed as an O-ring retained overdenture. The female portions of the metalloceramic crowns of teeth 13 and 23 could not be captured in this way. Even thus, given the technical and financial limitations, the proposed treatment addressed all esthetic and functional patient demands

Nondecalcified histologic study of bone response to titanium implants topographically modified by laser with and without hydroxyapatite coating.

The purpose of this study was nondecalcified histologic analysis of titanium implants modified by laser with and without hydroxyapatite. Implants with three modified surfaces were inserted into rabbit tibias: group 1, machined surface; group 2, irradiated (laser); and group 3, irradiated and hydroxyapatite coated (biomimetic method). The mean surface roughness (Ra) scores of groups 2 and 3 were higher than that of group 1. Boneimplant contact measurements at 30 and 60 days for groups 2 and 3 were higher than for group 1. Bone area at 30 and 60 days for group 2 was higher than for groups 1 and 3. Titanium implants modified by laser with and without hydroxyapatite exhibit increased early osseointegration.

Reabilitação total dos maxilares com carga imediata / Full mouth rehabilitation using immediate implant loading

O carregamento moderado e controlado dos implantes suporta e reforça a osteogênese, podendo aumentar a superfície de contato osso-implante. Isto ocorre porque quando as células osteoprogenitoras são expostas a uma deformação física limitada, a sua diferenciação em osteoblastos é melhorada. Neste momento, alguma variação de microtensão é considerada vantajosa para a neoformação óssea assim como para a osseointegração. A estabilidade primária é um dos principais pré-requisitos clínicos para o controle da micromovimentação entre o implante e o tecido de formação interfacial, o que ajuda a determinar o ambiente mecânico adequado para a osteogênese. Com base nos aspectos biológicos do carregamento de implantes imediatos, o objetivo deste estudo é apresentar um caso clínico de reabilitação total dos maxilares com carga imediata. Sete implantes foram colocados na maxila e seis na mandíbula seguindo-se a instalação de duas próteses do tipo protocolo com carga imediata, uma vez que a estabilidade primária foi alcançada para todos os implantes. Instruções sobre a função mastigatória e como ela está relacionada com a micromovimentação dos implantes foram abordadas e enfatizadas para o paciente. A razão por essa opção de tratamento foi de reduzir o tempo de tratamento, devolução de estética e função para o paciente. Após dois anos de acompanhamento clínico, os autores concluíram que a reabilitação maxilomandibular simultânea com carga imediata pode ser indicada e realizada após um planejamento adequado do caso clínico com base na tomografia computadorizada, proporcionando estética e função imediatas para o paciente

Moderate and controlled loading of the implants support or enhance osteogenesis, which may augment the bone-to-implant contact area. This occurs because when osteoprogenitor cells are exposed to limited physical deformation, their differentiation into osteoblasts is enhanced. Then, some range of microstrain is considered advantageous for bone ingrowth and osseointegration. The primary stability has been considered one of the main clinical requisitions for controlling micro motion between the implant and the forming interfacial tissue, which helps to establish the proper mechanical environment for osteogenesis. Based on the biological aspects of immediate implant loading, the objective of this study was to present a clinical case of immediate full mouth rehabilitation. Seven dental implants were placed in the maxilla and six in the mandible followed by the installation of both immediate- -load prosthetic protocols, once primary stability was reached for all implants. In addition, instructions about masticatory function and its relation with interfacial micro motion were addressed and emphasized to the patient. This treatment was chosen aiming at reducing the period of treatment and restore function and aesthetics. After a 2 year follow-up of the rehabilitation, the authors could conclude that simultaneous maxillomandibular rehabilitation with immediate loading can be indicated and performed after a well establish treatment planning based on computed tomography, providing immediate aesthetic and function to the patient

Commercially pure titanium implants with surfaces modified by laser beam with and without chemical deposition of apatite. Biomechanical and topographical analysis in rabbits.

OBJECTIVES: The purpose of this study was to evaluate the surfaces of commercially pure titanium (cp Ti) implants modified by laser beam (LS), without and with hydroxyapatite deposition by the biomimetic method (HAB), without (HAB) and with thermal treatment (HABT), and compare them with implants with surfaces modified by acid treatment (AS) and with machined surfaces (MS), employing topographical and biomechanics analysis. METHODS: Forty-five rabbits received 75 implants. After 30, 60, and 90 days, the implants were removed by reverse torque and the surfaces were topographically analyzed. RESULTS: At 30 days, statistically significant difference (P < 0.05) was observed among all the surfaces and the MS, between HAB/HABT and AS and between HAB and LS. At 60 days, the reverse torque of LS, HAB, HABT, and AS differed significantly from MS. At 90 days, difference was observed between HAB and MS. The microtopographic analysis revealed statistical difference between the roughness of LS, HAB, and HABT when compared with AS and MS. CONCLUSIONS: It was concluded that the implants LS, HAB, and HABT presented physicochemical and topographical properties superior to those of AS and MS and favored the osseointegration process in the shorter periods. In addition, HAB showed the best results when compared with other surfaces.

Bone augmentation and autogenous transplantation of premolar to the site of the fissure in a cleft palate patient.

This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non-syndromic 10-year-old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients.

Comparative in vivo study of commercially pure Ti implants with surfaces modified by laser with and without silicate deposition: biomechanical and scanning electron microscopy analysis.

The purpose of this study was to evaluate commercially pure titanium implant surfaces modified by laser beam (LS) and LS associated with sodium silicate (SS) deposition, and compare them with machined surface (MS) and dual acid-etching surfaces (AS) modified. Topographic characterization was performed by scanning electron microscopy-X-ray energy dispersive spectroscopy (SEM-EDX), and by mean roughness measurement before surgery. Thirty rabbits received 60 implants in their right and left tibias. One implant of each surface in each tibia. The implants were removed by reverse torque for vivo biomechanical analysis at 30, 60, and 90 days postoperative. In addition, the surface of the implants removed at 30 days postoperative was analyzed by SEM-EDX. The topographic characterization showed differences between the analyzed surfaces, and the mean roughness values of LS and SS were statistically higher than AS and MS. At 30 days, values removal torque LS and SS groups showed a statistically significant difference (p < 0.05) when compared with MS and AS. At 60 days, groups LS and SS showed statistically significant difference (p < 0.05) when compared with MS. At 90 days, only group SS presented statistically higher (p < 0.05) in comparison with MS. The authors can conclude that physical chemistry properties and topographical of LS and SS implants increases bone-implant interaction and provides higher degree of osseointegration when compared with MS and AS.

Considerações cirúrgicas e não cirúrgicas para a escolha do número de implantes nas reabilitações dos quatro incisivos superiores / Surgical and non-surgical considerations for choosing the number of implants to rehabilitate the four maxillary incisors

A reabilitação dos quatro incisivos superiores com implantes osseointegráveis continua sendo um grande desafio para os profissionais, por ser uma área com alto nível de exigência estética e pela dúvida em relação ao número de implantes a serem utilizados. O objetivo deste trabalho foi revisar a literatura sobre os aspectos fundamentais das reabilitações com implantes osseointegráveis na pré-maxila (quatro incisivos superiores), visando um maior resultado estético para o paciente. Um levantamento bibliográfico foi realizado entre os anos de 1991 a 2013, na base de dados PubMed, sendo usada a palavra chave anterior tooth restauration. Dos 30 artigos avaliados inicialmente, foram selecionados 14: cinco revisões da literatura, sete estudos experimentais em humanos e dois estudos experimentais em cães. Os estudos mostraram que a quantidade de implantes a ser utilizada nas reabilitações de pré-maxila ainda é muito controvertida, não sendo condição sine qua non para a obtenção do sucesso estético. Para determinar a escolha do número de implantes, o profissional deve atentar-se e levar em consideração alguns fatores de suma importância, tais como: o espaço protético, o diâmetro do implante e sua plataforma, além de distâncias verticais e horizontais entre implante-implante e dente-implante. Além desses fatores descritos, o sucesso estético dependerá ainda da altura da crista óssea, do volume tecidual, do correto posicionamento do implante, do apoio proximal das coroas e da linha do sorriso. Portanto, os autores puderam concluir que existem muitos outros elementos a serem considerados nas reabilitações de pré-maxila que, como visto, se sobrepõem ao número de implantes.

Rehabilitation of the four maxillary incisors with dental implants remains a major challenge for professionals due to high aesthetic requirements and doubts regarding the number of implants to be used. The objective of this study was to review the literature on the fundamental aspects of premaxilla rehabilitation (the four upper incisors) toward a greater aesthetic result for the patient. A literature review of articles published from the year 1991 until 2013 indexed in PubMed database was conducted. The key word: “anterior tooth restauration”. Among 30 initially retrieved references, 14 articles were selected: five literature reviews, seven experimental studies in human and two experimental studies in dogs. The studies had shown that the number of implants to be used in the rehabilitation of the four upper incisors of the premaxilla is still very controversial and is not the only condition to achieve aesthetic success. For choosing the number of implants, professionals should take into consideration prosthetic space, implants platform and diameter, vertical and horizontal distances between implants and between tooth and implant. Moreover, aesthetic success will also depend on the height of bone crest, tissue volume, correct implant positioning, proximal support of the crowns, and the smile line. Thus, it can be concluded that there are many other factors to consider beyond the number of implants in the rehabilitation of the four upper incisors.

Características e particularidades do plasma rico em fibrina (L-PRF) na regeneração óssea / Characteristics and particularities of plasma-rich fibrin (L-PRF) for bone regeneration: a literature review

O plasma rico em fibrina (L-PRF) pertence a mais nova geração de concentrados de plaquetas orientados para preparação simplificada sem a manipulação bioquímica do sangue. O objetivo deste trabalho foi revisar a literatura sobre o uso do plasma rico em fibrina na regeneração óssea e descrever suas características e particularidades. Para isso, foi realizado um levantamento bibliográfico dos artigos publicados nos anos de 2006 a 2012, indexados na base de dados Pubmed. Foi empregada a palavra-chave: plasma rico em fibrina. Dos 46 artigos avaliados inicialmente foram selecionados 21 que avaliaram o uso do PRF na Implantodontia, dentre eles: cinco revisões da literatura, oito estudos experimentais em humanos, dois estudos experimentais em animais, seis estudos in vitro. Concluiu-se que esta opção terapêutica é uma alternativa viável para regeneração óssea. Nos estudos in vitro pôde-se observar que a polimerização lenta durante a preparação do PRF parece gerar uma rede de fibrina muito semelhante ao natural, desencadeando maior migração e proliferação celular e consequente regeneração óssea. Os estudos in vivo mostraram maior área de neoformação óssea nos grupos PRF e a associação de PRF a biomateriais diminuiu o tempo de espera para a colocação dos implantes. Diante disto, pôde-se concluir que esta opção terapêutica é uma alternativa viável para regeneração óssea. Entretanto, mais pesquisas são necessárias para desvendar o potencial biológico do PRF, assim como o melhor entendimento da sua composição para que obtenhamos melhores resultados clínicos.

Platelet-rich fibrin (L-PRF) belongs to the youngest generation of platelet concentrates oriented for simple preparation without blood biochemical manipulation. The objective of this study was to perform a literature review on the use of platelet-rich fibrin for bone regeneration describing its characteristics and particularities. A literature review of the published articles from the year 2006 until 2012 indexed in Pubmed database was conducted. The key word: platelet-rich fibrin was used for this purpose. Among 46 reviewed articles initially selected, 21 articles that have evaluated the use of PRF in implant dentistry were selected among them: 5 literature reviews, 8 experimental humans studies, 2 experimental animal studies, 6 studies in vitro. In vitro studies had shown that the slow polymerization during the preparation of L-PRF appears to generate a fibrin very similar to natural triggering greater cell migration and proliferation and consequently bone regeneration. In vivo studies had shown greater amount of neoformed bone area in PRF groups and the association of PRF with biomaterials had decreased the wait time to place the implants. Based on the literature review, the authors can conclude that Platelet-rich fibrin is a viable option to be used for bone regeneration. However, more research is needed to unravel the L-PRF biological potential as well as a better understanding of its composition in order to improve clinical results.

Evaluation of centrifuged bone marrow on bone regeneration around implants in rabbit tibia.

OBJECTIVE: To evaluate the bone regeneration of cervical defects produced around titanium implants filled with blood clot and filled with centrifuged bone marrow (CBM) by means of histomorphometric analysis. MATERIALS AND METHODS: Twelve rabbits received 2 titanium implants in each right tibia, with the upper cortical prepared with a 5-mm drill and the lower cortex with a 3-mm-diameter drill. Euthanasia was performed to allow analysis at 7, 21, and 60 days after operation. The samples were embedded in light curing resin, cut and stained with alizarin red and Stevenel blue for a histomorphometric analysis of the bone-to-implant contact (BIC) and the bone area around implant (BA). The values obtained were statistically analyzed using the nonparametric Kruskal-Wallis test (P = 0.05). RESULTS: At 60 days postoperation, the groups had their cervical defects completely filled by neoformed bone tissue. There was no statistically significant difference between the groups regarding BIC and BA during the analyzed periods. CONCLUSION: There was no difference in the bone repair of periimplant cervical defects with or without the use of CBM.

Osteoconductive properties of ß-tricalcium phosphate matrix, polylactic and polyglycolic acid gel, and calcium phosphate cement in bone defects.

Extensive bone defects in maxillofacial region can be corrected with autogenous grafts; otherwise, the disadvantages of the therapeutics modality take the research for new bone substitutes. The aim of the study was to evaluate and compare the osteoconductive properties of 3 commercial available biomaterials. A total of 30 calvarial defects (5-mm diameter) were randomly divided into 5 treatment groups, with a total of 6 defects per treatment group (n = 6). The treatment groups were as follows: 500 to 1000 µm ß-tricalcium phosphate (ß-TCP), polylactic and polyglycolic acid (PL/PG) gel, calcium phosphate cement, untreated control, and autograft control. The evaluations were based on histomorphometric analysis at 60 postoperative days. The results have shown that ß-TCP and autograft control supported bone formation at 60 postoperative days. ß-Tricalcium phosphate showed the highest amount of mineralized area per total area and statistically significant compared with PL/PG, calcium phosphate cement, and untreated control groups. The PL/PG gel does not have osteoconductive properties and performed similar to empty control. Calcium phosphate cement showed higher number of multinucleated giant cells around the sites of the biomaterial and showed newly formed bone only at the edges of the biomaterial, without bone formation within the biomaterial. The findings presented herein indicate that bone formation reached a maximum level when rat calvarial defects were filled with ß-TCP at 60 postoperative days. Further studies should be conducted with ß-TCP to understand the potential of this biomaterial in bone regeneration.

Bioactive glass for alveolar ridge augmentation.

The restoration and recovery of the alveolar healing process are a challenge to dental surgeons to achieve satisfactory results at the osseointegration of implants and implant rehabilitation. Different operative technique and biomaterials are being used to reconstruct the framework of the alveolar process. One of the biomaterials used for this purpose is the bioactive glass. The aim of this study was to report clinical and histologic final results of 7 clinical reports of alveolar ridge augmentation using bioactive glass. Clinically, bioglass was able to maintain bone architecture of the alveolar bone and repaired satisfactory. Biopsy was performed on the histologic samples and showed bone formation in intimate contact to the particles of the biomaterial.

Mandibular rehabilitation using immediate implant loading after computer-guided surgery.

Computed tomographic scan is a precise complementary examination of diagnostic imaging and a noninvasive surveying technique that enables the professional to improve precision of implant placement by building a prototype that allows the confection of surgical guides. The authors present a clinical case of mandible rehabilitation based on computed tomography of a patient; the cross sections were reformatted and used to construct a virtual planning of the implants and a guide template in Dental Slice. Immediate loading of 5 titanium implants were placed in the mandible using a Slice Guide System. This technique allows a better surgical planning, makes the procedures more accurate, and reduces surgery time.