Three-Dimensional Imaging and Guided Surgery for Dental Implants

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Key points

  • As technology continues to improve, and imaging modalities become widely available, clinicians worldwide are increasingly adopting guided surgical applications for dental implants.

  • All aspects of the 3-D interactive treatment planning phase are based on sound surgical and restorative fundamentals.

  • As an integral part of the implant team, dental laboratories have now moved from analog to the digital world, providing the necessary support to the new digital workflow.

  • Guided surgery applications are

Case presentation

A 62-year-old man presented with a preexisting maxillary reconstruction and a lower failing reconstruction (Fig. 13). The maxillary reconstruction needed replacement, as the vertical dimension of occlusion was compromised (overopened by 5.5 mm), making it difficult for the patient to function or speak properly. The panoramic view as reconstructed from the CBCT dataset shows the existing implants in the maxilla, and failing teeth supporting a fixed bridge in the anterior mandible, 3 existing

Surgical intervention

Using local anesthetic agents, the anterior mandibular fixed bridge and teeth were removed (Fig. 26). A full-thickness mucoperiosteal flap was performed to debride the tooth sockets and decorticate for subsequent bone grafts. The tooth borne template was placed over the existing crowns, and the fit verified through the inspection windows (Fig. 27A). The sequential drilling was performed through the proper-diameter guide keys, which fit into the cylinders embedded in the surgical guide (see

Restorative phase

The patient was monitored for the 8-week period before impressions were taken to complete the restoration (Fig. 30). The newly placed implants exhibit parallelism, which aides in the laboratory phase of prosthesis construction and passivity of fit. A stone cast, which incorporated implant analogs, was fabricated and verified with a rigid intraoral verification index. CAD CAM software was used to design the framework for the definitive restoration. The diagnostic wax-up was scanned and imported

Summary

As the technology continues to improve, and imaging modalities become widely available, clinicians worldwide are increasingly adopting guided surgical applications for dental implants. Although CT/CBCT diagnosis and treatment planning are still not universally taught in dental schools at either the undergraduate or postgraduate levels, clinicians are becoming more aware of the benefits of proper planning through advanced imaging modalities and interactive treatment planning applications. It

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