Immediate loading of two freestanding implants placed by computer-guided flapless surgery supporting a mandibular overdenture with magnetic attachments  Daisuke Sato, DDS, PhD, Manabu Kanazawa, DDS, PhD, You-kyoung Kim, DDS, Sawako Yokoyama, DDS, PhD, Yuri Omura, DDS, Masahiko Ozeki, DDS, PhD, Shunsuke Minakuchi, DDS, PhD, Shohei Kasugai, DDS, PhD, Kazuyoshi Baba, DDS, PhD  Journal of Prosthodontic Research  Volume 60, Issue 1, Pages 54-62 (January 2016) DOI: 10.1016/j.jpor.2015.09.002 Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 1 Outline of the protocol. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 2 (a) Patient's complete denture used as a radiographic guide, (arrow) gutta percha markers placed as reference points. (b) Customized surgical guide that contains two guided sleeves for implant installation and three sleeves for anchor pins. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 3 Virtual 3-dimensional image of (a) anatomical architecture and (b) the combined radiographic guide. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 4 Position of two parallel implants simulated in the intraforaminal region. Three anchor pins are also placed virtually for fixation of the surgical guide. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 5 Two-dimensional image of the cross-section of bone at the implant position. Longest implants possible within the safety zone are placed. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 6 Intra-oral photographs (a) before surgery, and (b) of the surgical guide stabilized by anchor pins. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 7 Intra-oral photograph of the surgical guide held steady by the operator's hands, with local anesthesia injected by another operator through a sleeve of an anchor pin. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 8 Intra-oral photographs (a) after the implants are inserted, and (b) after magnetic abutments are connected. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 9 Panoramic X-ray (a) before surgery, (b) 1 week after surgery, and (c) 2 years after surgery. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 10 Intra-oral photograph 2 years after surgery. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions

Fig. 11 Photograph of the final denture. Journal of Prosthodontic Research 2016 60, 54-62DOI: (10.1016/j.jpor.2015.09.002) Copyright © 2015 Japan Prosthodontic Society Terms and Conditions