108 Chapter 7 Putters et al.12. The particulate bone grafts were covered by the corticocancellous bone block and fixed with two screws (1.5-mm diameter; Martin Medizin Technik, Tuttlingen, Germany; Fig. 7.1b). The flap was deflected and sutured with resorbable sutures (Vycril 3-0, Ethicon, Somerville, New Jersey, USA). Antibiotics (500mg amoxicillin three times daily for 7 days) and chlorhexidine (twice daily for 14 days) were prescribed. All the patients were instructed not to wear their denture for two weeks. Thereafter, the denture was adjusted and relined with a resilient material (Reline Extra Soft, GC, Leuven, Belgium). After a 4 month healing period of the reconstructed sites, dental implants were placed under general anaesthesia. An epi-alveolar incision was made to reflect a buccal flap. After removing the fixation screws, four to six sandblasted and acid-etched tissue level implants (Straumann AG, Basel, Switzerland) were placed according to a conventional surgical template. All implants were 4.1mm in diameter and had a minimum length of 10mm. After instalment, the flap was deflected and sutured with resorbable sutures. Again, all the patients were instructed not to wear their dentures for two weeks, after which the denture was adjusted and relined with a resilient material. Following 3 months of osseointegration, a bar-retained maxillary IOD was made. After completion of the surgical and prosthodontic treatment, participants were referred back to the referring dentists for routine recalls. The referring dentists were advised to follow a standard maintenance protocol consisting of yearly routine dental check-ups and supportive oral hygiene treatment. Evaluation and outcome measures After signing informed consent, all the participants were scheduled for an evaluation visit. Patient characteristics, treatment characteristics and complications were obtained from the patient’s medical files. Outcome measures were implant survival (primary outcome measure), marginal bone level change (MBLC), clinical parameters and patient related outcome measures (PROMs). Implant survival Implant survival was defined as the percentage of implants present at time of evaluation. A replacement implant was considered a failure with the occurrence of implant loss, persistent pain, mobility, a MBLC of >50% of the implant length or fracture of the implant. Marginal bone level change Baseline radiographs and additional data concerning complications during treatment were obtained from patients’ records. At evaluation, one additional panoramic radiograph was made (Figure 7.1). MBLC was measured by one blinded observer (HJAM) by comparing the panoramic radiographs taken directly after loading (baseline) and at time of the evaluation visit. Implant length was used as a reference when assessing bone loss on the radiographs and was measured between the tip and outer border of the neck of the implant.
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