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By T. Stejnar. Wentworth Institute of Technology. 2019.

Novel oral anticoagulants: efficacy order 800 mg cialis black otc statistics on erectile dysfunction, laboratory measurement cheap cialis black 800 mg without prescription erectile dysfunction age 16, and approaches to emergent reversal. Development of blood transfusion product pathogen reduction treatments: a review of methods, current applications and demands. Microparticle, nanoparticle, and stem cell-based oxygen carriers as advanced blood substitutes. American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative 1171 Blood Management*. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage. Safe limits of isovolemic hemodilution and recommendations for erythrocyte transfusion. Red blood cell transfusion in the treatment and management of anaemia: the search for the elusive transfusion trigger. Transfusion of banked red blood cells and the effects on hemorrheology and microvascular hemodynamics in anemic hematology outpatients. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy. Plasma and plasma protein product transfusion: A Canadian blood services centre for innovation symposium. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time. Effect of a fixed-ratio (1:1:1) transfusion protocol versus laboratory-results-guided transfusion in patients with severe trauma: a randomized feasibility trial. Prevalence of survivor bias in observational studies on fresh frozen plasma: Erythrocyte ratios in trauma requiring massive transfusion. The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012. Approaches to minimize infection risk in blood 1174 banking and transfusion practice. Infectivity of human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus and risk of transmission by transfusion. A comparison of human immunodeficiency virus, hepatitis C virus, hepatitis B virus, and human T- lymphotropic virus marker rates for directed versus volunteer blood donations to the American Red Cross during 2005 to 2010. The residual risk of transfusion-transmitted cytomegalovirus infection associated with leucodepleted blood components. Leukoreduction for the prevention of adverse reactions from allogeneic blood transfusion. Bacterial contamination in platelets: incremental improvements drive down but do not eliminate risk. Detection of septic transfusion reactions to platelet transfusions by active and passive surveillance. Pharmacological interventions for the prevention of allergic and febrile non-haemolytic transfusion reactions. The entity of immunoglobulin A-related anaphylactic transfusion reactions is not evidence based. Relative IgA-deficient recipients have an increased risk of severe allergic transfusion reactions. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. Blood transfusion in cardiac surgery does increase the risk of 5-year mortality: results from a contemporary series of 1714 propensity-matched patients. In vitro transfusion of red blood cells results in decreased cytokine production by human T cells. Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series. Characterizing the epidemiology of postoperative transfusion-related acute lung injury. Low-risk transfusion-related acute lung injury donor strategies and the impact on the onset of transfusion-related acute lung injury: a meta-analysis. Cytokines and clinical predictors in distinguishing pulmonary transfusion reactions. Nonlethal, attenuated, transfusion- associated graft-versus-host disease in an immunocompromised child: case report and review of the literature. Characterizing the epidemiology of perioperative transfusion-associated circulatory overload. A retrospective review of patient factors, transfusion practices, and outcomes in patients with transfusion- associated circulatory overload. Preoperative autologous blood donation: Waning indications in an era of improved blood safety. Ranking the effectiveness of autologous blood conservation measures through validated modeling of independent clinical data. Preoperative acute normovolemic hemodilution for minimizing allogeneic blood transfusion: A meta-analysis.

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A significant decrease in claims related to death/brain death at the induction of anesthesia is not matched with similar progress during emergence and in the postoperative period best cialis black 800 mg erectile dysfunction doctor in columbus ohio. Although the closed claims data is useful buy discount cialis black 800mg line erectile dysfunction or gay, it has significant4 limitations, including its retrospective nature and the lack of a denominator. This chapter will reflect the need to7 consider these five factors when approaching any patient who requires or may require airway control. This text will focus on routine and rescue airway management techniques that are the fundamentals upon which all airway management is based. Review of Airway Anatomy The term airway refers to the upper airway—consisting of the nasal and oral cavities, pharynx, larynx, trachea, and principal bronchi. Because the oroesophageal and nasotracheal passages cross each other, anatomic and functional complexities have evolved for protection of the sublaryngeal airway against aspiration of food passing through the pharynx. As are other bodily systems, the airway is not immune from the influence of genetic, nutritional, and hormonal factors. The anatomically complex airway undergoes significant changes in its size, shape, and relationship to the cervical spine from infancy into childhood. Note that the cricoid cartilage is <1 cm in height in its anterior aspect, but may be 2 cm in height posteriorly. The laryngeal skeleton consists of nine cartilages (three paired and three unpaired); together, these house the vocal folds, which extend in an anterior– posterior plane from the thyroid cartilage to the arytenoid cartilages. The shield-shaped thyroid cartilage acts as the anterior “protective housing” of the vocal mechanism (Fig. Movements of the laryngeal structures are controlled by two groups of muscles: the extrinsic muscles, which move the larynx as a whole; and the intrinsic muscles, which move the various cartilages in relation to one another. The larynx is innervated by the superior and recurrent laryngeal nerves, which are branches of the vagus nerve. Because the recurrent laryngeal nerves supply all of the intrinsic muscles of the larynx (with the exception of cricothyroid muscle), trauma to these nerves can result in vocal cord dysfunction. With unilateral recurrent laryngeal nerve injury, hoarseness is the primary symptom, though the protective role of the larynx in preventing aspiration may be compromised. Bilateral injury can 1904 result in complete airway obstruction due to fixed cord adduction and may be a surgical emergency. The membrane has a central portion known as the9 conus elasticus and two lateral thinner portions. Because of anatomic variability in the course of veins and arteries and the membrane’s proximity to the vocal folds (which may be 0. This2 should lead to routine examination of laryngeal structures, including the marking of surface anatomy, and the use of ultrasound identification, especially in at-risk patients (Fig. This cartilage is approximately 1 cm in height anteriorly, but almost 2 cm in height in its posterior aspect as it extends in a cephalad direction (Fig. The tracheal cartilages are 1905 interconnected by fibroelastic tissue, which allows for expansion of the trachea in both length and diameter with inspiration/expiration and flexion/extension of the thoracocervical spine. Inferiorly, the trachea is suspended from the cricoid cartilage by the cricotracheal ligament. The trachea measures approximately 15 cm in adults and is circumferentially supported by 17 to 18 C-shaped cartilages, with a membranous posterior aspect overlying the esophagus. The trachea ends at the carina (opposite the fifth thoracic vertebra), where it bifurcates into the principal bronchi. The right principal bronchus is larger in diameter than the left and deviates from the sagittal plane of the trachea at a less acute angle. Cartilaginous ring support continues through the first seven generations of the bronchi. History of Airway Management Prior to 1874, mechanisms of airway obstruction were poorly understood. Opening the mouth with a wooden screw and drawing the tongue forward with a forceps or a steel-gloved finger was the height of nonsurgical airway management. Not until 1880 was it recognized that most airway obstruction12 resulted from the tongue falling against the posterior pharyngeal wall. Over the next 50 years, several modifications of the basic13 oropharyngeal airway were described. In the 1930s, Ralph Waters introduced the now-familiar flattened tube oral airway. Arthur Guedel modified Waters’ concept by fitting his airway within a stiff rubber envelope in an attempt to reduce mucosal trauma. Tracheal intubation was first described in 1788 as a means of resuscitation of the “apparently dead,” but was not used for the delivery of anesthesia14 until almost 100 years later. O’Dwyer cared for pediatric patients suffering airway obstruction secondary to diphtherial pseudomembrane formations. He was aware of the work of Emile Trousseau, a French physician who reported having performed over 200 tracheostomies in patients with diphtheria. O’Dwyer, hoping to provide his patients nonsurgical relief from airway obstruction, designed brass tracheal tubes that were placed in the larynx using blind digital intubation technique. Franz Kuhn (1866–1929) developed 1906 a flexometallic tube that resisted kinking and could be shaped to the patient’s upper airway anatomy. The patients were intubated awake and the hypopharynx was sealed with oiled gauze packing. Sir Ivan Magill and Stanley Rowbotham are credited with the initial development of modern tracheal intubation. Performing anesthesia for reconstructive facial surgery during World War I, they developed a two-tube nasal system. One narrow tube (gum elastic design) was passed through the nares and guided into the larynx using a surgical laryngoscope. The other tube was blindly passed into the pharynx to provide for the escape of gases. During use of this “Magill” tube, the exhaust lumen would occasionally pass blindly into the larynx, leading Sir Ivan to describe “blind nasal intubation. Three factors led to the development of these devices: (1) the introduction of cyclopropane (which was explosive and required an airtight circuit for appropriate gas containment), (2) appreciation that blind and laryngoscope- guided tracheal intubation remained a difficult task, and (3) a need for protection of the lower airway from blood and surgical debris in the upper airway. The Primrose cuffed oropharyngeal tube, the Shipway airway (a13 Guedel oropharyngeal airway fitted with a cuff and a circuit connector designed by Sir Ivan Magill), and the Lessinger airway were predecessors of the modern supraglottic devices. In 1937, Leech introduced a “pharyngeal bulb gasway” with a noninflatable cuff that fit snugly into the hypopharynx. The description by Mendelson of gastric-content aspiration in parturients managed with a mask16 airway (66 of 44,016 patients, with 2 deaths) furthered the shift toward tracheal intubation in most surgical procedures. Within a few years, proficiency in direct laryngoscopy and tracheal intubation became a mark of professionalism. The advent of succinylcholine in 1951 furthered the dominance of tracheal intubation by providing rapid and profound muscle relaxation. By 1981, two types of airway management prevailed—tracheal intubation and facemask ventilation with or without a Guedel airway. Tracheal intubation was associated with dental and soft tissue injury as well as cardiovascular stimulation, and mask ventilation often required a prolonged hands-on-the-airway technique. Archie Brain conceived the idea of fitting a mask-like structure over 1907 the larynx.

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Classifcation of acute pancreatitise2012: revision of the Atlanta classifcation and defnitions by interna- tional consensus purchase cialis black 800 mg with amex erectile dysfunction drugs and heart disease. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage order 800 mg cialis black otc erectile dysfunction drugs over the counter uk. Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis. Results from the international confer- ence of experts on intra-abdominal hypertension and abdominal compartment syndrome. Early recognition of abdominal compart- ment syndrome in patients with acute pancreatitis. Decompressive laparotomy with temporary abdominal closure versus percutaneous puncture with placement of abdominal catheter in patients with abdominal compartment syndrome during acute pancreatitis: background and design of multicenter, randomised, controlled study. Clinical rel- evance of intra-abdominal hypertension in patients with severe acute pancreatitis. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury. Pediatric Guidelines Sub-Committee for the World Society of the Abdominal Compartment Syndrome. Intra-abdominal hypertension and the abdominal compartment syn- drome: updated consensus defnitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Early continuous veno- venous haemofltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years’ experience. Surgical management of abdominal compartment syndrome; indications and techniques. Clinical characteristics and management of patients with early acute severe pancreatitis:experience from a medical center in China. Surgical decom- pression for abdominal compartment syndrome in severe acute pancreatitis. Decompressive laparotomy for abdominal compart- ment syndrome: a critical analysis. Improved outcome by identifcation of high-risk nonocclusive mesenteric ischemia, aggressive reexploration, and delayed anastomosis. Indications and results of second-look operation in acute mesenteric vascular occlusion. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. The measurement of intraabdominal pressure as a criterion for abdominal re-exploration. Early detection of major complications after abdominal aortic sur- gery: predictive value of sigmoid colon and gastric intramucosal pH monitoring. Colonic ischaemia and intra-abdominal hypertension following open repair of ruptured abdominal aortic aneurysm. Open abdomen treat- ment following endovascular repair of ruptured abdominal aortic aneurysms. Intra-abdominal pressure and renal func- tion after surgery to the abdominal aorta. Intra-abdominal hypertension and abdominal com- partment syndrome following surgery for ruptured abdominal aortic aneurysm. Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms. Intraabdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Delayed abdominal closure in the management of ruptured abdominal aortic aneurysms. Moore In the 1980s, it became recognized that patient survival could be improved by limit- ing surgery to critical maneuvers including control of surgical hemorrhage and con- trol of spillage from hollow visceral injuries [1–4]. This “damage control” approach was generally targeted at patients sustaining massive intra-abdominal trauma, with hypothermia, acidosis, and coagulopathy triggering a “bloody vicious cycle” that culminated in rapid demise. The decision to abort laparotomy is usually related to recalcitrant coagulopathy and the bloody vicious cycle but may be additionally infuenced by other factors such as inadequate blood products, limited surgical expertise, or multiple casualties. Bleeding solid organs and open retroperitoneal spaces should be packed and topical hemostatic agents used as necessary. This may involve stapled or suture closure of bowel injuries and drainage of biliary or pancreatic lacerations. Our preference is the “Vac-Pack” technique, performed similar to that described by Barker and colleagues (Fig. A sterile polyethylene plastic sheet is fenestrated to allow egress of ascites fuid and then spread over the bowel and extending under the abdominal wall laterally to the paracolic gutters. A towel is placed over the top of the sheet, flling the wound and as an additional barrier to bowel protrusion. However, in the scenario of high risk for ongoing bleeding, the towel is omitted to facilitate direct observation of the peritoneal cavity. Two silastic drains are placed along the wound edges to evacuate the ascites fuid from the wound. These may be tunneled through the skin or laid on top of the skin and brought out at the cephalad aspect of the wound. Finally, the entire wound and a generous margin of skin are covered with an incise drape. We favor an iodophor-impregnated drape that is adhesive and contains some antibacterial properties. The silastic drains are con- nected to bulbs, and the bulbs are connected to continuous wall suction, as ascites is produced at a high level during resuscitation. Iodophor-impregnated incise fascia, exiting toward the drape extends over entire patient’s head opening; Drains placed to wall suction Fig. Ongoing bleeding can be occult, particularly if blood is contained deep within the abdomen and not reaching the drains. Correction of coagulopathy is essential to limit hemorrhage and to restore physio- logic normality prior to returning for defnitive surgery. In other cases, such as when a major liver injury is packed, it may be best to wait longer so that the packs may be removed with less chance of rebleeding. Resuscitation should be targeted at correcting coagulopathy as well as reversing metabolic acidosis. Continued bleeding or failure to correct acidosis may be indi- cators of uncontrolled surgical bleeding or ischemic viscera. Nutritional support should be provided early, and the enteral route is preferred to enhance pro- tein availability. Data from a multicenter prospective cohort study indicate that immediate enteral nutrition after damage control is safe, with no adverse effect on abdominal closure rate [12]. In addition, the investigators found a reduction in pneumonia associated with immediate enteral nutrition, consistent with previous work in injured patients.

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The nasal spine mucosal-submucosal fap and leaving intact periosteum over the can be removed with a rongeur if needed buy cialis black american express erectile dysfunction in 20s. If the periosteum is left intact discount cialis black 800mg without a prescription erectile dysfunction oil, a pseudomembrane osteum there with several 4-0 chromic catgut horizontal mattress will form rapidly and rapid reepithelialization will follow (Figure 1 sutures on a small 2 round needle. A scar band may be present for prepared stent) can be useful and it is border-molded with green many months after this procedure and the denture fange exten- compound, relined with a soft reline material, and fxated to the sion should be limited to be short of this, but in time the band maxilla with screws as described earlier. Te procedure was originally pre- thesia with a vasoconstrictor throughout the lower anterior 22 23 sented by Kazanjian and modifed by Godwin, who pre- vestibule. The most inferior margin of the At the junction of the aforementioned fap and the periosteum periosteum fap is also incised horizontally at the desired depth of the mandible, an incision is made through the submucosa of the vestibule (Figure 18-5, C). Denture construction can commence about a week after A pressure dressing similar to one that would be used in a genio- surgery is completed with the labiobuccal fange slightly underex- plasty procedure is applied, to be left for 2 days or longer if tended for several months (Figure 18-5, E). C, Te periosteum is incised superiorly at the crest of the ridge and laterally anterior to the mental foramina, refected beyond the projected depth of the vestibule, and incised again just above the depth of the periosteal dissection, leaving a periosteal tag to which the mucosa can be sutured. D, Te pedi- cled mucosa is sutured to the inferior periosteal margin and the superior periosteum margin is sutured to the margin of the lip mucosa. E, A patient who had a lip switch myotomy is wearing his existing denture showing how much additional fange extension is possible after E this procedure. In such cases, the surgeon should modify the case-specifc needs to achieve favorable results. Soft tissue pull fxed mucosa is not an essential requirement for successful can be alleviated by vestibuloplasty procedures in a supraperi- 15-17 implant restorations, none would argue that if it is pos- osteal plane and placement of skin, mucosal, or Alloderm sible to obtain fxed mucosa where implant abutments and grafts. Ingenuity is again applicable here with stent usage, as attachments emerge, it is preferable. Such a situation is fre- frequently stents can be placed at such surgeries and retained quently noted where implants are placed in a markedly by integrated or completely stable implants (Figure 18-7). Prosthetic restoration requires improved gingival drape and additional implant fxtures. B, Surgical stent fabricated for surgery tried in the mouth for ft and adjustment. Avoidance and Management of Intraoperative Postoperative Considerations Complications Te patient should be adequately prepared for the level of Intraoperative complications are rare with vestibuloplasty pain and swelling that will accompany vestibuloplasty proce- techniques. With skin graft acquisition, care must be used to dures, and he or she should be provided with a reliable anal- avoid grafts that are too thick, bleeding should be controlled gesics. Te patient should be informed that the wearing of prior to dressing with topical hemostatic agents, the graft dentures will be prohibited for about 2 to 3 weeks. Stents should be carefully stored in moist gauze until utilized to must remain well adapted to prevent loss of graft attachment. Dentures exercised to avoid mental nerve damage in the mandible and can be constructed when the patient is ready, but most of the infraorbital nerve damage in the maxilla. Hemostasis must vestibuloplasty techniques employed are accompanied by be meticulous, particularly in the foor of the mouth, to avoid shrinkage and relapse, so prosthetic intervention should be airway embarrassment. Weiser R: Ein jahr chirurgisch-zahnarztliche laspik, Dtsch Zahnartzl Z 14:629, 1959. Wassmund M: Ueber chirurgische formgestal- ment, Oral Maxillofac Surg Clin North Am vestibulum in periodontal therapy, Int Dent J tung des atrophisen kiefers zum zwecke 22:387, 2010. Trauner R: Alveoplasty with ridge extensions ence of keratinized mucosa, Oral Surg Oral 26. Obwegeser H: Die totale mundbodenplastik, infuence of soft tissue thickness on crestal sitional fap technique for mandibular vestibu- Schweiz Mschr Zahnheilkd 73:565, 1963. Mathis H: Einfache chirgische massnahmen spective controlled clinical trial, Int J Oral zur sicherung von halt und stabilitat der Maxillofac Implants 24:712, 2009. Gilbert Triplett and Jorge Gonzalez Armamentarium (Figure 19-1) #9 Molt periosteal elevator Disposal punch (for use with fapless Needle holder and suture Adson tissue forceps with teeth technique) (sizes 4. Numerous dental practitioners participated in advancing the art of dental implantology to solve the scourge of edentulism. Per-Ingvar Brånemark who revolutionized the art and science of dental implantology with his discovery of the utility of titanium in 1952 while studying methods to improve orthopedic surgery. He discovered that bone would bond irreversibly to implanted titanium screw-shaped cylinders. He demonstrated, under carefully controlled conditions, that at the light microscopic level, titanium could structurally integrate with living bone. He further confrmed that this could be achieved with a high degree of predict- comfortably manage a normal-textured diet because of the ability and without long-term soft tissue infammation, mobility of the denture. Implant surface bone resorbs, and the bone loss in height and width causes a technology was advanced by Schroeder and Letterman, who poor ft for the removable denture; in addition, dislodgement developed a titanium plasma spray coating with a one-piece from the perioral musculature becomes greater than the transmucosal screw. Likewise, the use of implants to support a prosthesis in partially edentulous patients may eliminate the need for crown prep on teeth adjacent to the edentulous space Indications for the Use of the Procedure that will be used as bridge abutments. If removal of Te placement of dental implants is indicated to support nonfunctioning or nonrestorable teeth is necessary, it is advis- tooth replacements in edentulous and partially edentulous able to consider the best replacement choice for that particu- arches. Endosteal root form implants have been shown to lar patient; if an implant-supported prosthesis is indicated, support crown and bridge replacement for missing teeth in a extraction and immediate implant placement should be con- very predictable manner, with low failure and complication sidered based on the diagnosis and treatment planning. Implant and prosthetic design and service characteris- may minimize resorptive alveolar bone loss after extraction tics have improved success rates and shortened the osseoin- and allow for a less complex restoration. Implant Patients who are missing teeth may be good candidates placement and function can minimize the morbidity of eden- for an implant-supported prosthesis. Patients who are eden- tulism and improve function and quality of life for these tulous in the mandible, in particular, may not be able to patients. The character of the The examination should encompass the entire oral cavity, includ- gingival soft tissue and the amount and location of attached and 7 ing the dentition and edentulous sites, jaw relationship, and occlu- unattached tissue should be assessed and recorded. The edentulous areas should be evaluated for height, width, teeth should be free of decay and periodontally healthy. Some advantages of this technology are Once implant treatment planning has been determined, the data reduced operating time, minimal surgical trauma, a shorter post- 9 can be sent to manufacturing facilities for a guide splint and operative recovery period, and less pain (Figure 19-3, A). Worldwide, approxi- mately 600 different options can be chosen, although most are sharp burs, chilled irrigation, and light drilling pressure all mini- 10 mize temperature elevation during bone site preparation (Figure similar in form and surgical steps. Most of the endosseous implant systems use a series of incrementally larger-diameter 19-3, B). The fap design should be carefully planned are present, they can be removed and the ridge fattened with to allow access and good visibility. A crestal incision is made over side-cutting rongeurs or a vulcanite bur and fnished with bone the proposed implant site, and the mucoperiosteal fap is elevated fles. The ridge is measured to assure that the width is adequate 6 to expose the underlying bone; this allows the surgeon to ade- (i. A quately identify and avoid vital structures and also to identify bony customized, sterilized surgical template (guide) is placed in posi- irregularities and undercuts. It is recommended that implant margins be no and Sequence closer than 2 mm to natural teeth and 3 mm to adjacent implants. The starter bur (#2 round) is drilled into the center of each pro- The frst twist drill (1.

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