Clinical Case No. 27: AMSJI, Patient Specific Implants, Cutting Guide VOG and HOG

Abstract

A female patient, 59 years old, is in good general health (ASA 1). She came to our observation, with a fixed prosthesis on teeth and blade implants, affected by periodontitis and peri-implantitis. CT examination confirmed that teeth and implants had to be extracted. After the extractions we waited a few months for the healing of tissues and then performed a new CT with a scan prosthesis and double scan protocol. CT showed defects in height in the posterior areas an defect in thickness in the anterior portion of the arch, with a knife-edge-alveolar ridge. A bone crest too thin is not favorable even for a custom made implant, such as the AMSJI. In this situations, the subperiosteal implant would embrace the knife-blade ridge forming pointing areas that could use soft tissue dehiesences. In order use the AMSJI technique also in the IV class of Cawood-Howell, we defined a protocol for guided osteotomy to be performed at the same time of the implant positioning when possible, to allow a more harmonious design of the AMSJI and with less sharp parts. More detail on the technique are published in: Rinaldi M, De Neef B, Loomans NA, Mommaerts MY. Guidelines for the use of resection guides for subperiosteal maxillary implants in cases of terminal dentition-A novel approach. Ann Maxillofac Surg 2020;10:467−71.