Surgical procedures

External antisepsis was performed on the face using 2% Riorex chlorhexidine digluconate (Rioquímica, São José do Rio Preto, SP, Brazil) and intrabuccal (intraoral) antisepsis was performed using digluconate 0.12% chlorhexidine (Colgate, São Paulo, SP, Brazil). The entire maxilla was anesthetized using 4% articaine and 1:100,000 epinephrine (DFL, Rio de Janeiro, Brazil). A side window of approximately 1.5 cm in diameter was made on the right and left maxilla using a long drill (diamond, spherical, 3018HL, KGSorensen, Cotia, SP, Brazil). The lifting of the sinus membrane was performed with the aid of curettes (Hu-Friedy, Chicago, USA).

Following this, the prototyped surgical guide (Fig. 3) was installed and stabilized, and the guide was positioned for spear drilling (Fig. 4).

After initial drilling, guide and drilling using a long milling cutter (3.0 mm, spiral, lance type) were performed up to the length required for the implant placement. The implant was placed using a contra-angle mount (Fig. 4b), with the final insertion using a ratchet or tufted wrench (Fig. 4c). The mini-abutment guide was placed, coupled to the implant placed, and with the use of a guide set and more milling cutter to install the mini-abutments, to ensure drilling accuracy. Subsequently, the mini-pillars were placed (KOPP, Curitiba, PR, Brazil), according to the length of the transmucosal between the Morse cone and the gingival margin. Simple sutures were used to reposition the folded soft tissue (Fig. 5).

The prescription included 0.2% chlorhexidine digluconate mouthwash to be used three times a day, starting 2 days before the procedure until 10 days after; paracetamol 500 mg, every 6 h for 4 days; dexamethasone 4 mg, every 12 h for 2 days; and amoxicillin 875 mg, every 12 h for 7 days. In case of persistent pain, Tramadol 50 mg was prescribed.