# Magnetic Mallet and Laser for a Minimally Invasive Implantology: A Full Arch Case Report
## 2 Materials, Methods and Results
### Surgical Procedure  
On the day of the surgery, the patient took an antibiotic prophylaxis based on Amoxicillin and clavulanic acid (875 mg + 125 mg) one hour before the start of the surgery. Initially, complete anesthesia of the upper arch was performed on both the buccal and palatal sides, using, as the anesthetizing molecule, articaine with the addition of adrenaline at a concentration of 1: 100,000. A full-thickness flap was initially performed to clinically highlight the total residual bone volume of the superior alveolar process, root residues and implants. The simple extraction of the remaining dental elements was then performed. Instead, for the removal of root residues and implants, the Magnetic Mallet was used with the inserts for the extractions. This made it possible to avoid osteotomy and/or odontomy maneuvers in order to save precious bone tissue for the subsequent insertion of the implants. Given the presence of infection and inflammatory tissue, photodynamic therapy (OHLLT protocol) (Figure 5a,b) was practiced in the post-extraction sockets by irrigation with a Sioxyl solution activated by a diode laser (parameters), to decontaminate in depth. Subsequently, for each of the eight implant sites, a series of steps were performed in order to insert the implants with sufficient primary stability and in the best prosthetic position to make the intervention as predictable but also as minimally invasive as possible. Figure 4: Intraoral photos of the patient (**a**) and orthopantomography (**b**) and CBCT 3D reconstruction (**c**) and cross sections (**d**). Figure 5: Oxygen high level laser therapy, OHLLT (**a**); measurement of the post-extraction site (**b**). Initially, the erbium laser (160 mj, 20 Hz, with an average power of 3.2 W) was used to bleed the bone tissue and thus increase the regenerative potential. At the same time, the ablative capacity of the erbium laser allowed the creation of an access for the osteotomy inserts of the Magnetic Mallet. The implant sites, in fact, were prepared using only the Magnetic Mallet with osteotomic inserts of an increasing diameter, from 100 (apical diameter of 1 mm) to 300 (apical diameter of 3 mm) (Figure 6a). Therefore, no bone tissue was removed, but it was only compacted to increase its density and obtain greater primary stability. Before inserting the implants, the implant sites were in turn decontaminated by photodynamic therapy (OHLLT protocol). The eight implants were then inserted (Figure 6b) with a torque of 35 N in zone 17 and 24 (diameter 4, length 10), zone 14 (diameter 4, length 11), zone 21 and 23 (diameter 4, length 13), zone 11 and 13 (diameter 3, 7, length 13) and zone 26 (diameter 4.7, length 10). Finally, the healing screws were screwed to the implants and the flaps were sutured with a 4-0 silk thread after placing the PRF previously taken and they were centrifuged both in the extraction sites and to protect the flaps. After the insertion of all the implants, the primary stability was measured with an implant dynamometer ratchet and it was found to be good, with values of about 35 N.  
For the realization of the prosthetic product, the impressions were made. Above, by implant transfers, an impression was made with plaster mixed with fluid silicone, while at the bottom an alginate impression was made. (Figure 7a) Once the surgery was completed, the patient was given an anti-inflammatory drug based on naproxen sodium 550 mg (Synflex) to avoid the onset of pain. Before being discharged, the patient underwent a photobioomodulation session using the ATP38 (Biotech Dental, Salon-de-Provence, France) for 12 min. Figure 6: Use of the Magnetic Mallet to prepare the implant site (**a**); implant insertion (**b**). Figure 7: Transfer on implants to make the impression (**a**); healing caps on implants (**b**); prosthesis with immediate loading after 48 h (**c**).