Amr Hosny Elkhadem, DDS, MSc
Lecturer, Prosthodontics, Faculty of Oral & Dental medicine, Cairo University
The keyless partial guidance using the simple guide kit and c-shaped sleeves is a promising economic alternative to conventional guided approach. Further investigations are required to evaluate
its accuracy and long term success rates.
www.SimpleGuideSystem.com
http://www.permadontics.com Dr. Berger and Dr. Aires are leading researchers in Dental implant technologies. Often lecturing and writing research papers for the industry and other doctors.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
http://www.permadontics.com Dr. Berger and Dr. Aires are leading researchers in Dental implant technologies. Often lecturing and writing research papers for the industry and other doctors.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
PURPOSE: To report the clinical outcomes of implantation of a new Ferrara intrastromal corneal ring segment (ICRS) with a 210-degree arc length in eyes with keratoconus.
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Xoran's xCAT - high resolution low dose head CTBritaMed Inc.
Introduction of the xCAT: Xoran's most powerful CT Scanner to date, offering sub-millimeter resolution for superior geometrical accuracy.
The xCAT radiation dose is a small fraction of conventional head CT, while the entire scanner is compact and portable using a 4 wheels design.
Videocephalometry/certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Excepcional artigo produzido pela Dra. Jordana Sandes do CEROF, GO mostra os efeitos dos arcos de 140º em Ceratocones com valores de astigmatismo elevados.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
PURPOSE: To report the clinical outcomes of implantation of a new Ferrara intrastromal corneal ring segment (ICRS) with a 210-degree arc length in eyes with keratoconus.
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
Xoran's xCAT - high resolution low dose head CTBritaMed Inc.
Introduction of the xCAT: Xoran's most powerful CT Scanner to date, offering sub-millimeter resolution for superior geometrical accuracy.
The xCAT radiation dose is a small fraction of conventional head CT, while the entire scanner is compact and portable using a 4 wheels design.
Videocephalometry/certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Excepcional artigo produzido pela Dra. Jordana Sandes do CEROF, GO mostra os efeitos dos arcos de 140º em Ceratocones com valores de astigmatismo elevados.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Профилактика заболеваний уха, горла и носа (в том числе при беременности)Мария Идк
Пора отпусков и поездок на море еще в самом разгаре. К сожалению, для многих отпуск на море заканчивается такими неприятными последствиями как заложенность в ушах или насморк. В период беременности ЛОР заболевания могут неблагоприятно сказаться на здоровье будущей мамы и ее малыша. Что делать, чтобы предотвратить заболевания органов носоглотки и ушей?
Вы узнаете:
• как предотвратить лор-заболевания
• что делать, чтобы уберечь себя от боли в ушах
• какие есть простые меры профилактики синусита и ангины
Temporary Anchorage Device (TAD) or Mini (screw ,implant)Khaled Wafaie
Orthodontic Temporary Anchorage Device (TAD) or Mini (screw ,implant).
I am hoping that this presentation is beneficial for everyone
For more information and for further contact join us on ( Orthodontic Institution) Group on Facebook.
Abstract: Immediate implant placement has been the acceptable procedure for the past two decades. Perhaps
the most important aspect of any implant surgery in accordance with the successful procedure is implant
surgery and bone to implant contact.The aim of this article is to describe a clinical case in which a fractured
maxillary canine was replaced by an immediately loaded postextraction implant using a simplified technique,
which permits a reduction of the number of implant components and consequently a lower cost of treatment,
while at the same time maintaining acceptable aesthetic and functional outcomes.
Key words: Immediate implant placement, Immediate loading, Immediate provisionalisation, Esthetics
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case P...Shilpa Shiv
Journal Club On Pre-extractive Interradicular Implant Bed Preparation: Case Presentations of a Novel Approach to Immediate Implant Placement at Multirooted Molar Sites, IJPRD 2013.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
The Tall Tilted Pin Hole Placement Immediate Loading.pptxNishu Priya
The Tall Tilted Pin Hole Immediate Loading (TTPHIL) concept has evolved from various ideologies in implantology: basal, pterygoid, and angulated/tilted implants under immediate loading.
To maximize the success of rehabilitation, the TTPHIL technique utilizes the use of long tilted bicortical implants. Longer implants have more bone to implant contact, thus, improving osseointegration.
By engaging the alveolar and nasal cortex, hard tissue augmentation procedures and vital structures in the premaxilla are avoided.
In the posterior maxilla, pterygoid implants are placed.
Reconstruction of a facial defect is a complex modality either surgically or prosthetically, depending on the site, size, etiology, severity, age, and the patient’s expectation. The loss of an auricle, in the presence of an auditory canal, affects hearing, because the auricle gathers sound and directs it into the canal.
Surgical reconstruction is preferable but prosthetic approach may be necessary in some circumstances such as the presence of complex or large defects, requirement of the recurrence control, local or general contraindications of surgery, damaged neighboring tissues due to the radiotherapy, general poor health, failed reconstructive attempts previously made, refusal of the surgery by the patient, high esthetic demands, the desire for a quick recovery and palliatively operated patients.
Nowadays, craniofacial implants are used to support and retain such prostheses. Studies have shown successful retention and stability of auricular prostheses anchored to the temporal bone with titanium implants.
International Journal of Engineering Research and DevelopmentIJERD Editor
Electrical, Electronics and Computer Engineering,
Information Engineering and Technology,
Mechanical, Industrial and Manufacturing Engineering,
Automation and Mechatronics Engineering,
Material and Chemical Engineering,
Civil and Architecture Engineering,
Biotechnology and Bio Engineering,
Environmental Engineering,
Petroleum and Mining Engineering,
Marine and Agriculture engineering,
Aerospace Engineering.
“One-Piece” Immediate-Load Post-Extraction Implant In Maxillary Central IncisorAbu-Hussein Muhamad
Abstract: This case report describes extraction of a fractured left maxillary central incisor tooth, followed by immediate placement of an one-piece implant in the prepared socket and temporization by a bonded restoration.
Materials And Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. The socket was prepared to the required depth and a Implant was inserted.
Results: The atraumatic operating technique and the immediate insertion of the one-piece Implant resulted in the preservation of the hard and soft tissues at the extraction site.
Conclusion: The “One-piece” dental implant and provisional restoration provided the patient with immediate esthetics, function, comfort and most importantly preservation of tissues. The one-piece implant design resulted in a high cumulative implant survival rate and beneficial marginal bone levels.
Similar to The Journal of Implant & Advanced Clinical Dentistry - Oct. 2015 (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
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combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The Journal of Implant & Advanced Clinical Dentistry - Oct. 2015
1. Elkhadem et al
Background: to describe the con-
cept and use of a simplified keyless
guided implant placement system in
partially and completely edentulous patients.
Methods: 89 implants were placed in 23
patients (7 complete, and 16 partial cases)
using the universal simple guide kit. After
CBCT and virtual implant planning, surgi-
cal guides with c-shaped sleeves were con-
structed. The implants were placed using flap
or flapless approach according to the need
for soft or hard tissue augmentation. The intra-
operative complications, post-operative com-
plains and implant survival rate were reported.
Results: All implants demonstrated insertion
torque values greater than 30 Ncm. Only few
post- operative complications were reported.
98.9% of the placed implants integrated.
Conclusions: The keyless partial guid-
ance using the simple guide kit and c-shaped
sleeves is a promising economic alterna-
tive to conventional guided approach. Fur-
ther investigations are required to evaluate
its accuracy and long term success rates.
The Keyless Partially Guided Implant
Placement Protocol: Success Rate
and Complications
Amr Hosny Elkhadem, DDS, MSc1
1. Lecturer, Prosthodontics, Faculty of Oral & Dental medicine, Cairo University
Abstract
KEY WORDS: Computer-aided Implantology, surgical guide, open sleeve, tolerance
The Journal of Implant & Advanced Clinical Dentistry • 25
2. 26 • Vol. 7, No. 8 • October 2015
INTRODUCTION
The use of CT scans combined with computer
software to plan implant cases has been pro-
posed since the 1990s.1
The technique aims
to provide correlation between the bone anat-
omy and the desired tooth position allowing
for predictable aesthetic and functional out-
comes. Many authors refer to guided implant
placement as a protocol that enhances the
accuracy and safety of implant placement.2-4
Moreover, it allows for the minimally invasive
flapless technique in many situations, which
minimizes the intra-operative time, postopera-
tive pain and postoperative complications.4,5
Despite of the aforementioned advan-
tages the techniques is not popular among
implant practitioners. This might be attributed
to the higher cost and time required to plan
the cases and fabricate the guides. Expensive
guided implant kits with complex assortment
are also mandatory.6
Additionally, the control
over implant direction is usually achieved with
a closed circular configuration with small drill
tolerance. Using the relatively longer drills for
guided systems through such closed configu-
ration was always associated with accessibil-
ity problems in the posterior region for dentate
patients. Such a small tolerance is manda-
tory to provide accuracy, yet it is thought to
block the passage of the irrigation and might
cause increased incidence of implant fail-
ure in dense bone and deep osteotomies7
Moreover, there is an uprising question
related to the accuracy imposed by the mechan-
ical tolerance of the machined components. To
provide adequate precision of the guided sys-
tems, a small gap of approximately 20 microns
is provided between the main sleeve fixed in
the guide and the removable, diameter spe-
cific, keys. A similar tolerance gap is designed
between the removable keys and the drills. The
friction during repeated use of the keys and
the drills increases the gap obviously which
might contribute to increases linear and angu-
lar deviation with these guided systems.8,9
When weighing the merits and demer-
Figure 1: The simple guide kit. (a) cortical drill, (b) 2.3 mm
starter drill, (c,d,e) 2.2 mm pilot drill with variable lengths,
(f) 2.8 mm intermediate drill.
Figure 2: Surgical guide with c-shaped sleeve establishing
3 mm facial openings for side approach of the drills.
Elkhadem et al
3. The Journal of Implant & Advanced Clinical Dentistry • 27
its of conventional guided systems one can
understand why such protocol is not so pop-
ular. Hence, there is a great need to pro-
vide modification in the concept and design
of guided surgical approach to overcome
the drawbacks and maximize the benefits.
MATERIALS AND METHODS
The technique utilizes a simplified universal kit
design (Simple guide kit, Dentis Co.-Ltd, Daegu,
South Korea) and a modified C-shaped main
sleeve. The kit design eliminates the removable
keys used in conventional guided kits, and adopt
the concept of guidance for the pilot and inter-
mediate drills only. For all cases, the final drill-
ing is done after removing the surgical guide
using the conventional non-guided final drills.
The design and sequence of the simplified
kit is different from the regular guided implant
drills (Fig 1). All drills are composed of cutting
flutes and a smooth guiding shaft that is com-
patible in size with the main sleeve of the surgi-
cal guide with no removable key in between. The
drilling sequences starts with a pointed drill for
penetration of the cortical bone. A starter drill
(2.3x8mm) is used to create an initial osteotomy
inside the bone. This is followed by the use of
pilot drills (2.2mm in diameter). The pilot drills
have variable lengths according to the desired
implant to be placed. As the pilot drill diameter is
smaller than the initial osteotomy created by the
starter drill, it will snap into the osteotomy engag-
ing 8 mm of vertical bone height and part of its
guiding shaft will engage the main sleeve of the
guide. In all scenarios, a 2.8x8mm intermediate
drill is used afterwards to prepare the coronal
Figure 3: Virtual implant planning for an edentulous case. Implants were placed in relation to the required prosthetic
position guided by the radio-opaque scan appliance.
Elkhadem et al
4. 28 • Vol. 7, No. 8 • October 2015
8 mm of the osteotomy. As the osteotomy path
is shaped the surgical guide is removed and the
final drill of the conventional kit is used to cre-
ate the final osteotomy shape. This is followed
by inserting the implant in the conventional non
guided fashion. Additionally, the surgical guide
is designed with a c-shaped metal sleeve with a
facial opening (Fig 2). The opening allows for side
approach of the drills and unrestricted access of
the coolant. In this report, 23 cases were oper-
ated. 89 implants were installed in 7 completely
edentulous and 16 partially edentulous cases.
COMPLETELY
EDENTULOUS CASES
37 implants were installed in 7 completely
edentulous cases (two mandibular and 5 max-
illary) using this technique. Preparation started
by duplicating the patient denture into radio-
opaque scan appliance (Barium sulphate to
acrylic resin 1:4). Holes were prepared in the
tooth centre of the proposed site to facilitate its
identification on the CT scan. Double scan tech-
nique was performed. The first scan was done
with the patient wearing the scan appliance
and biting on cotton rolls allowing for teeth
separation. The second scan was made for
the scan appliance alone. Virtual planning was
performed using Blue sky Plan (Bluesky Bio,
LLD – USA). The virtual implants were placed
in the required anatomical sites after correlat-
ing them to the desired tooth positions (Fig 3).
3D superimposition of the scan appliance was
done over the patient CT scan using a point
registration technique (Fig 4). After defining
the diameter, height and offset of the guiding
tubes the software generated the virtual guide
by binding the scan appliance to the guiding
Figure 4: Point registration of the scan appliance over the patient scan. Several points are selected to minimize the
superimposition errors.
Elkhadem et al
5. The Journal of Implant & Advanced Clinical Dentistry • 29
tubes. The STL file of the guide was fabricated
using additive manufacturing. C-shaped sleeves
were fixed in the surgical guide and the guid-
ing tubes were opened facially opposite to the
sleeve openings (Fig 2). The guide was fixed
in the patient mouth with 3 fixation screws and
the suggested drilling sequence was applied.
PARTIALLY
EDENTULOUS CASES
52 implants in 16 partially edentulous cases
(7 mandibular and 9 maxillary) were placed.
Patient scanning protocol differed according to
the number of missing teeth and the presence
of metallic restorations. In cases with few miss-
ing teeth and few or no metallic restoration, the
patient received a CBCT with no scan appli-
ance. The patient model was scanned using a
laser scanner. When the patient had multiple
missing teeth and /or numerous metallic resto-
rations a scan appliance with radiopaque mark-
ers was first prepared. The patient had a CBCT
wearing the scan appliance. Afterwards, a
CBCT for the patient model with the scan appli-
ance was made for superimposition purposes.
Virtual planning was done after correlating the
prosthetic position to the underlying bone anat-
omy. When no scan appliance existed virtual
tooth setting was utilized. When designing the
guide, extension over the adjacent teeth as well
as part of the palatal and lingual mucosa was
required to assure proper stability. All cases not
requiring grafting were done in a flapless man-
ner (Fig 5). In cases requiring bone grafting a
flap was first raised and the guide was then
used for implant placement (Fig 6). When extra
security was required to fix the guide in place
light-cured flowable composite was used to tem-
porarily bond the guide to the supporting teeth.
RESULTS
No major intra-operative complications or
problems were reported in either flap or flap-
less cases. In few cases the c-shaped sleeves
were detached off the guide when contact-
ing the drills. The sleeves were replaced and
the procedure completed. All implants dem-
onstrated acceptable implant stability at inser-
Figure 5: A bilateral flapless maxillary case. Plan was made to avoid enlarged sinus on the left side (a). The guide design
allowed implant placement at the tuberosity region (b).
Elkhadem et al
6. 30 • Vol. 7, No. 8 • October 2015
Figure 6: An anterior maxillary case with labial bone deficiency. The guide was placed after flap elevation to guide ideal
implant drilling (a), which was followed by GBR procedures (b).
tion (more than 30 Ncm). There was no reports
of postoperative infections among all partici-
pants. Only 4 patients reported postoperative
pain that lasted more than one week after the
surgery. The rest of the patients reported no
postoperative pain or mild pain for few days.
Only two case (one flap and one flapless)
reported transient post-operative oedema. At
the second stage, only one maxillary implant
failed with overall success rate of 98.9%.
DISCUSSION
The keyless partially guided technique seems
to offer numerous advantages. First, the elimi-
nation of the removable keys together with the
open shaped sleeves allowed for better acces-
sibility during surgery especially in the poste-
rior region up to the maxillary tuberosity. The
open guiding sleeves allowed also for unre-
stricted access of the irrigation during drilling.
The proposed simplified approach did not
compromise the control over osteotomy prep-
aration at all stages of drilling. The use of a
short starter (2.3x8mm) drill created an ini-
tial osteotomy channel that accommodated
the smaller pilot drill. This assured dual guid-
ance of the pilot drill by engaging the initial
osteotomy apically and the guiding sleeve cor-
onally. The path created by the pilot and inter-
mediate drill is so definite that it guides further
drilling with minor possibilities of introduce
a change in the osteotomy direction or depth.
Final drills with blunt non cutting tip are usu-
ally preferred because they seem to be safer.
By eliminating the removable keys only
one mechanical tolerance is present instead
of the two gaps in the conventional guided
approaches. Theoretically, this will reduce the
mechanical tolerance error to the half. Minimiz-
ing the error introduced by the bur sleeve gap
is thought to be a crucial factor in reducing the
intrinsic errors imposed by guided surgery 8-9
As the majority of cases were flapless, the
incidence of post-operative pain and compli-
cations were less.10-11
As the guide are based
on 3D implant planning on CBCT, direct expo-
Elkhadem et al
7. The Journal of Implant & Advanced Clinical Dentistry • 31
sure of bone was not utilized unless soft
and / or hard tissue augmentation was required.
Moreover, conservative transmucosal drill-
ing was used. Tissue punch was not used
as there is no proven clinical advantage or
impact on the implant success rate when com-
pared to transmucosal drilling. On the con-
trary, the increase in the size of the punched
tissue is thought to increase the probing
depth and crestal bone loss around implants.12
A debate exist about the accuracy of partial
guidance in comparison to classical fully guided
systems. While some practitioners might believe
that guided final drilling and insertion signifi-
cantly affect the accuracy others believe that
guidance of the initial osteotomy provides suf-
ficient guidance to the rest of the procedures.
The clinical data regarding the survival rate
and accuracy of partial versus full guidance is
still sparse.13
Kuhl et al.14
evaluated the accu-
racy of half versus fully guided techniques on
cadaver model. They found no statistical sig-
nificant difference between the two protocols.
Yet, there is a need to conduct more clinical tri-
als to evaluate the accuracy of both systems.
CONCLUSION
The use of the simplified partially guided key-
less approach seems to be a promising alter-
native to conventional guided surgery. The
technique allowed easy access to the poste-
rior region with efficient delivery of the irriga-
tion during drilling. The use of a small economic
universal kit might encourage many practitio-
ners to utilize guided surgery. Further stud-
ies are required to compare the accuracy
and success rate versus the conventional
guided techniques and manual techniques. ●
Correspondence:
Dr. Amr Hosny Elkhadem
e-mail: amrelkhadem@gmail.com
Address: 5 jasmine buildings zahraa elmaadi-
Cairo – Egypt
Postal code: 11435
Disclosure
The author reports no conflicts of interest with anything mentioned in this article.
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