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An appropriate identification of the tissue type that is in front of the excision surgical tool is critical, for either tumoral tissue removal, or even accessory healthy tissues whose destruction could cause severe collateral damage. Healthy tissue distinction is an unsolved task in real surgical praxis, due for instance to alterations or hemorrhages. Many approaches have tried to solve the problem of healthy tissue discrimination, such as spectroscopy. Diffuse Reflectance Spectroscopy (DRS), an easy to implement and reliable optical diagnostic technique, has shown great potential in tumoral tissue discrimination, as long as in healthy tissue distinction. However, the identification of nerve tissue in particular is challenging. What is more, nerve tissue distinction is critical in surgical interventions, due to the severe irreversible dysfunctions in patient mobility that collateral damage could cause. Fluorescence is an optical technique that could be of relevance for nerve identification. The need of specific fluorophores that tend to accumulate preferentially on nerve tissue is essential for this task. Image quality requires also an analysis of the optical source, filters employed, fluorophore concentration or inoculation method. Together with those aspects, additional open questions include incubation time or cytotoxicity, critical for clinical translation. In this work, fluorescence imaging for nerve identification is applied on in vivo rats. The approach uses several fluorophore concentrations, based on Oxazine, and combines topical and intravascular inoculation. Optical irradiance is considered for image contrast. The results show an appreciable nerve contrast for optimized parameters. This work has been partially supported by the project “High-pressure driven plasmonic and luminescence properties ofnaked and core/shell metal-oxide nanocomposites” (PGC2018-101464-B-I00) of the Spanish Ministry of Science, Research and Universities, cofunded by FEDER funds, and by the San Cándido Foundation.

RESUMEN Introducción: La cirugía guiada en pacientes edéntulos necesita un enfoque integral de los aspectos diagnósticos, quirúrgicos, prostodóncicos y de mantenimiento. El objetivo de este estudio era presentar la rehabilitación fija sobre implantes mediante una cirugía guiada asistida por ordenador en una paciente con edentulismo total maxilar. Caso clínico: Una paciente de 67 años es valorada para tratamiento con implantes del maxilar edéntulo. La paciente es evaluada mediante una tomografía computarizada de haz cónico para el diagnóstico del volumen óseo previo a la inserción de los implantes. Los datos obtenidos son utilizados para la planificación de tratamiento. 8 implantes maxilares son planificados y una férula guiada de resina es elaborada según esta información. Los implantes son insertados mediante una cirugía guiada sin colgajo con un fresado preciso. Después de un periodo de 4 meses, se realiza la carga diferida de los implantes mediante una rehabilitación fija maxilar. Conclusiones: Este caso clínico indica que la rehabilitación fija maxilar mediante un protocolo de cirugía guiada es un tratamiento implantológico con un exitoso resultado clínico. ABSTRACT Introduction: Guided surgery of edentulous patients need a comprehensive approach for diagnosis, surgery, prosthodontics and maintenance. The aim of this paper was to present the fixed rehabilitation with implants by computed assisted guided surgery of a patient with maxillary totally edentulism. Case report: A 67-year-women, is evaluated regarding implant treatment for the edentulous maxilla. The patient is assessed with a cone beam computarized tomography (CBCT) for diagnosis of bone volume for maxillary implant placement. The data from CBCT were used for treatment planning. Eight maxillary implants were treatment planned. Acrylic surgical guide is fabricated according digital data. Implants were inserted for a flapless surgical technique with an accuraced drilling. After a 4 months-period of time, a delayed loading of implants is realized for a maxillary fixed rehabilitation. Conclusions: This clinical case indicated that maxillary fixed rehabilitation by a guided surgery protocol is an implant treatment with a high clinical successful outcome.

RESUMEN Introducción: La cirugía guiada y la carga precoz de los implantes constituye un enfoque integral de la rehabilitación de los pacientes edéntulos. El objetivo del presente trabajo era presentar el protocolo diagnóstico, quirúrgico y protésico del tratamiento con implantes mediante la técnica de cirugía guiada y carga precoz en el tratamiento con sobredentadura con implantes. Caso clínico: Paciente varón de 68 años que acude a consulta para tratamiento con implantes de la mandíbula edéntula. La tomografía computarizada de haz cónico (CBCT) muestra que el paciente presenta un adecuado volumen óseo para la inserción de implantes. La información obtenida por la CBCT es utilizada para la evaluación y el plan de tratamiento. Se planificaron dos implantes interforaminales. Los datos digitales de imagen tomográfica fueron enviados a un centro especializado para la realización de la férula quirúrgica. De acuerdo a la férula guiada se insertaron los implantes sin colgajo con un fresado preciso. A las 6 semanas de la cirugía, una sobredentadura fue realizada y ajustada sobre los ataches, evaluando su oclusión. El periodo de seguimiento ha sido de 5 años. Conclusiones: Este caso clínico indica que la cirugía guiada puede constituir una terapéutica exitosa en el tratamiento del paciente edéntulo mandibular con sobredentaduras. ABSTRACT Introduction: Guided surgery and early functional loading of dental implants constitute a comprehensive approach for rehabilitation of edentulous patients. The aim of this paper was to present the diagnosis, surgical and prosthetic protocol of implants by guided technique and early loading in the treatment of edentulous mandible. Case report: A 68-year-old-man, requested an evaluation regarding implant treatment for the edentulous mandible. The cone beam computarized tomography (CBCT) showed that the patient have an adequate bone volume for mandibular implant placement. The data from CBCT were used for evaluation and treatment planning. Two implants were treatment planned. Digital data were sent to a software manufacturer for surgical template. According surgical template implants were inserted for a flapless surgical technique with an accuraced drilling. After a 6 weeks-period of time an overdenture were realized and finally, occlusion is evaluated. The follow-up were 5 years. Conclusions: This paper indicated that guided implant dentistry may constitute a successful treatment of edentulous mandible patients treated with overdentures

Introducción: La cirugía guiada y la carga precoz de los implantes constituye un enfoque integral de la rehabilitación de los pacientes edéntulos. El objetivo del presente trabajo era presentar el protocolo diagnóstico, quirúrgico y protésico del tratamiento con implantes mediante la técnica de cirugía guiada y carga precoz en el tratamiento con sobredentadura con implantes. Caso clínico: Paciente varón de 68 años que acude a consulta para tratamiento con implantes de la mandíbula edéntula. La tomografía computarizada de haz cónico (CBCT) muestra que el paciente presenta un adecuado volumen óseo para la inserción de implantes. La información obtenida por la CBCT es utilizada para la evaluación y el plan de tratamiento. Se planificaron dos implantes interforaminales. Los datos digitales de imagen tomográfica fueron enviados a un centro especializado para la realización de la férula quirúrgica. De acuerdo a la férula guiada se insertaron los implantes sin colgajo con un fresado preciso. A las 6 semanas de la cirugía, una sobredentadura fue realizada y ajustada sobre los ataches, evaluando su oclusión. El periodo de seguimiento ha sido de 5 años. Conclusiones: Este caso clínico indica que la cirugía guiada puede constituir una terapéutica exitosa en el tratamiento del paciente edéntulo mandibular con sobredentaduras. Introduction: Guided surgery and early functional loading of dental implants constitute a comprehensive approach for rehabilitation of edentulous patients. The aim of this paper was to present the diagnosis, surgical and prosthetic protocol of implants by guided technique and early loading in the treatment of edentulous mandible. Case report: A 68-year-old-man, requested an evaluation regarding implant treatment for the edentulous mandible. The cone beam computarized tomography (CBCT) showed that the patient have an adequate bone volume for mandibular implant placement. The data from CBCT were used for evaluation and treatment planning. Two implants were treatment planned. Digital data were sent to a software manufacturer for surgical template. According surgical template implants were inserted for a flapless surgical technique with an accuraced drilling. After a 6 weeks-period of time an overdenture were realized and finally, occlusion is evaluated. The follow-up were 5 years. Conclusions: This paper indicated that guided implant dentistry may constitute a successful treatment of edentulous mandible patients treated with overdentures

Introducción: La cirugía guiada y la carga inmediata de los implantes constituye un nuevo enfoque integral de la rehabilitación de los pacientes edéntulos. El objetivo del presente trabajo era presentar el protocolo diagnóstico, quirúrgico y protésico del tratamiento con implantes mediante la técnica de cirugía guiada y carga inmediata en el tratamiento del maxilar edéntulo. Caso clínico: Paciente varón de 70 años que acude a consulta para tratamiento con implantes del maxilar edéntulo. La tomografía computarizada de haz cónico (TCHC) muestra que el paciente presenta un adecuado volumen óseo para la inserción de implantes. La información obtenida por la TCHC es utilizada para la evaluación y el plan de tratamiento. Se planificaron diez implantes. Los datos digitales de imagen tomográfica fueron enviados a un centro especializado (Galimplant 3.D®) para la realización de la férula quirúrgica y la prótesis provisional. De acuerdo a la férula guiada se insertaron los implantes sin colgajo con un fresado preciso. La prótesis fija inmediata provisional fue realizada y ajustada sobre los pilares, evaluando su oclusión. La prótesis fija definitiva se realizó después de un periodo de 6 meses. Conclusiones: Este caso clínico indica que la implantología oral guiada puede constituir una terapéutica exitosa en el tratamiento del paciente edéntulo maxilar. Introduction: Guided surgery and immediate functional loading of dental implants constitute a new comprehensive approach for rehabilitation of edentulous patients. The aim of this paper was to present the diagnosis, surgical and prosthetic protocol of implants by guided technique and immediate loading in the treatment of edentulous maxilla. Case report: A 70-year-old-man, requested an evaluation regarding implant treatment for the edentulous maxilla. The cone beam computarized tomography (CBCT) showed that the patient have an adequate bone volume for maxillary implant placement. The data from CBCT were used for evaluation and treatment planning. Ten implants were treatment planned. Digital data were sent to a software manufacturer (Galimplant.3D®) and surgical template and fixed provisional prosthesis according clinical examination were received. According surgical template implants were inserted for a flapless surgical technique with an accuraced drilling. Immediate transitional fixed prosthesis were realized and adjusted with the abutment and finally, occlusion is evaluated. Definitive fixed prosthesis was realized after a 6 month-period of time. Conclusions: This paper indicated that guided implant dentistry may constitute a successful treatment of edentulous maxillary patients.