Precise dental implant placement in bone using surgical guides in conjunction with medical imaging techniques

The use of medical imaging techniques to make a very precise surgical guide for implant placement is described. This template is the combination of a currently used template and a very simple mechanical system designed to transfer a preoperatively defined implant position onto the surgical site. With the planning software, the practitioner determines the implant position according both to the ideal position dictated by the final restorative prosthesis and the available volume of bone. The surgical template then communicates the actual implant position to the surgical site. The template can be used not only in critical anatomical situations but also in placing the implant in an ideal position on bone because it eliminates possible manual placement errors and matches planning to prosthetic requirements.     

Clinical application of stereolithographic surgical guides for implant placement: preliminary results

BACKGROUND: The success of implant-supported restorations requires detailed treatment planning, which includes the construction of a surgical guide. Recently, computer-aided rapid prototyping has been developed to construct surgical guides in an attempt to improve the precision of implant placement. The aim of the present study was to evaluate the match between the positions and axes of the planned and placed implants when a stereolithographic surgical guide is employed. METHODS: Six surgical guides used in four patients (three women, one man; age from 23 to 65 years old) were included in the study and 21 implants were placed. A radiographic template was fabricated and computer-assisted tomography (CT) was performed. The virtual implants were placed in the resulting 3-dimensional image. Using a stereolithographic machine, liquid polymer was injected and laser-cured according to the CT image data with the planned implants, generating three surgical guides, with increasing tube diameters corresponding to each twist drill diameter (2.2, 3.2, and 4.0 mm), for each surgical area. During the implant operation, the surgical guide was placed on the jawbone and/or the teeth. After surgery, a new CT scan was taken. Software was used to fuse the images of planned and placed implants, and the locations and axes were compared. RESULTS: On average, the match between the planned and the placed implant axes was within 7.25 degrees +/- 2.67 degrees ; the differences in distance between the planned and placed positions at the implant shoulder were 1.45 +/- 1.42 mm, and 2.99 +/- 1.77 mm at the implant apex. In all patients, a greater distance was found between the planned and placed positions at the implant apex than at the implant head. CONCLUSIONS: Clinical data suggest that computer-aided rapid prototyping of surgical guides may be useful in implant placement. However, the technique requires improvement to provide better stability of the guide during the surgery, in cases of unilateral bone-supported and non-tooth-supported guides. Further clinical studies, using greater number of patients, are necessary to evaluate the real impact of the stereolithographic surgical guide on implant therapy.     

Accuracy and complications of computer-designed selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation

Background: Computer‐aided dental implant placement seems to be useful for placing implants by using a flapless approach. However, evidence supporting such applications is scarce. The aim of this study is to evaluate the accuracy of and complications that arise from the use of selective laser sintering surgical guides for flapless dental implant placement and immediate definitive prosthesis installation. Methods: Sixty implants and 12 prostheses were installed in 12 patients (four males and eight females; age range: 41 to 71 years). Lateral (coronal and apical) and angular deviations between virtually planned and placed implants were measured. The patients were followed up for 30 months, and surgical and prosthetic complications were documented. Results: The mean ± SD angular, coronal, and apical deviations were 6.53° ± 4.31°, 1.35 ± 0.65 mm, and 1.79 ± 1.01 mm, respectively. Coronal and apical deviations of <2 mm were observed in 82.67% and 58.33% of the implants, respectively. The total complication rate was 34.41%; this rate pertained to complications such as pulling of the soft tissue from the lingual surface during drilling, insertion of an implant that was wider than planned, implant instability, prolonged pain, midline deviation of the prosthesis, and prosthesis fracture. The cumulative survival rates for implants and prostheses were 98.33% and 91.66%, respectively. Conclusions: The mean lateral deviation was <1.8 mm, and the mean angular deviation was 6.53°. However, 41.67% of the implants had apical deviation >2 mm. The complication rate was 34.4%. Hence, computer‐aided dental implant surgery still requires improvement and should be considered as in the developmental stage.     

分置式可测量种植导板在多颗前牙即刻种植即刻修复中的应用

本文报道1例应用分置式可测量种植导板引导的即刻种植即刻修复技术,修复牙外伤所致的12—22牙缺失。术前根据咬合记录,在exoCAD软件中设计上部目标修复体空间轮廓位置,再通过口内和锥形束CT图像实测获得12—22牙位点近远中向、唇腭向和𬌗龈向分别在软硬组织水平的空间数据,在Bluesky Plan 4软件中设计比选4个正确种植位点,确认后设计并通过三维打印制作基于三向位置数值的可测量种植导板。术中使用3组可测量种植导板结合测量尺实测依次完成定点、半钻预备及轴向核查、全程预备及三向位置核查和种植体植入,之后再次实测核查种植位点。术后通过转移导板即刻戴入基于目标修复体空间和原天然牙穿龈形态设计、并于术前切削完成的临时修复体。经术后对比测量,种植入口点平均线性偏差为（0.57±0.17）mm,种植止点平均线性偏差为（0.82±0.27）mm,各植体平均角度偏差为（1.86±0.89）°,实现了12—22牙位点种植体的精准植入与同期的即刻修复。     

牙支持式先锋钻种植手术导板指引下种植体植入偏离情况

目的:研究先锋钻种植手术导板指引下种植体植入时的偏差情况。方法:采用CBCT对25例患者,已完成导板进行扫描并导出三维数字模型的38颗种植体,在mimics软件中将导板三维模型与患者种植术后锥形束投照计算机重组断层影像设备(CBCT)数据进行配准。然后测量种植体中心线在计划与实际种植体肩端水平和根端水平的垂直距离中心线及最大交角。结果:所有病例均顺利完成手术和临床修复。修复完成时间4-18个月,无种植体松动、脱落。植入的种植体与种植导板导引指定位置的肩端偏差0.83±0.49mm;根端偏差1.51±1.26mm;轴向偏离5.90±3.84度。结论:导板可保证预定植入方案的顺利进行,种植体实际位置与预定位置之间有轻微偏差,但影响轻微。     

A surgical guide for dental implant placement in edentulous posterior regions

Proper implant placement is crucial for successful implant-supported restorations. This article describes a simple technique for fabricating a vacuum-formed surgical guide to assist in dental implant placement in edentulous posterior regions.     

The relationship between cigarette smoking and dental implant failure

This paper examines the effect of tobacco use on the failure rates of dental implants. A review of 56 dental implant patients with a total of 187 endosseous dental implants, placed over a four year period, demonstrated a significant association between increased implant failure rates and cigarette smoking with failure rates of 16.6% in smokers compared to 6.9% in non-smokers. Also implant length was shown to be a significant factor with shorter implants (< or = 10 mm) being more susceptible to failure in smokers. A chi-square test was used for data analysis. Current recommendations that should be given to implant patients who smoke are included.     

Surgical guide for dental implant placement

Restorative problems with less than desirable implant placement can be challenging. A procedure is presented for the fabrication of a surgical guide stent that dictates placement of dental implants. This surgical guide can enhance implant placement in an efficient and acceptable manner so that final restorations can be properly contoured and esthetic.     

Surgical guidelines for dental implant placement

The goal of an implant supported reconstruction is to obtain optimal aesthetics and function. In order to achieve this, visualisation of the final restorative reconstruction is necessary prior to beginning treatment. The term 'restorative-driven' treatment planning has been used to identify this process. It requires a team approach of specialists, who can develop a multi-disciplinary treatment plan. It starts with an accurate diagnosis, which will lead to a prognosis of each individual tooth and the overall dentition. This information will help the clinician develop the treatment options suitable for tooth replacement. Only when the goals have been defined can the sequence of therapy be established. Working backwards from the wax-up of the final diagnostic model of the proposed treatment assists not only with the management of the complex case, but will help avoid mishaps. Effective communication between the team and the patient is extremely important. Understanding the patient's expectations is key to a successful outcome. Deciding that these expectations are realistic requires a correct diagnosis and an inter-disciplinary treatment plan that is logical. This approach takes time and requires a comprehensive treatment discussion between the team members, and then a thorough case presentation to the patient. Only then will the patient begin to understand the extent of their problem and the options available to reconstruct their mouth.     

一种实测实量引导植入位点的精准牙种植技术

正确的植入位点对于种植修复的长期稳定有效十分重要,为提高植入的精准度,临床上越来越多地使用外科导板、手术导航等来控制位点,引导种植体的植入。但是一方面由于这类数字化手段存在过程繁琐、费用较高等问题,大量的病例仍然是由自由手植入的;另一方面,在术前、术中、术后缺乏快速实用的实测位点的方法,不少病例只有术后锥形束CT检查时才发现位点不良,改正位点的代价不小。本文介绍一种适用于各类种植系统的全程植入位点的实测方法及其引导的精准植入技术。本技术由实测尺子引导,包括测量尺和术中定位尺两部分。术前使用测量尺测量术区三维空间,根据实测数据结合锥形束CT数据进行种植方案和数量引导设计,术中用实测尺子引导全程种植,兼顾实测核查。这种方法实现了植入手术从术前空间分析、术中精准植入引导及术后位点实测评价的全程可量化,可全程及时调整位点,提高了植入精度,是一项适宜推广的牙种植实用技术。     

The use and fabrication of a self-retaining surgical guide for controlled implant placement: a technical note.

A technique for using a surgical guide construction with a self-retaining feature, which has proven to be a significant improvement for stage 1 surgical procedures, is described. This design is more convenient to use than previously described occlusal extension splints. It maintains the concepts for ideal fixture placement that have proven so valuable in creating both a functionally and esthetically uncompromised prosthesis supported by implants.     

Fabrication of imaging and surgical guides for dental implants

Research and experience have suggested that the success of dental implants depends on a well-developed and careful treatment plan approach. Historically, implant size and angulation were determined with the use of panoramic radiographs and clinical judgment during surgery. This occasionally resulted in mechanical and esthetic compromise. This article describes the step-by-step fabrication process for 4 different imaging and surgical guides. Set-up disks, which enhance the design and fabrication of guides, also are introduced. These guides are used in conjunction with cross-sectional tomography during the preimplant assessment of surgical sites.     

A surgical guide for implant placement.

Mounted diagnostic casts aid in determining whether sufficient space exists for a fixed cantilevered implant prosthesis. These casts are also used to construct a surgical guide. Such a technique is described.     

Early implant placement following single-tooth extraction in the esthetic zone: biologic rationale and surgical procedures

Early implant placement is one treatment option for implant therapy following single-tooth extraction in the anterior maxilla. The surgical technique presented here is characterized by tooth extraction without flap elevation, a 4- to 8-week soft tissue healing period, implant placement in a correct three-dimensional position, simultaneous contour augmentation on the facial aspect with guided bone regeneration using a bioabsorbable collagen membrane combined with autogenous bone chips and a low-substitution bone filler, and tension-free primary wound closure. The surgical step-by-step procedure is presented with a case report. In addition, the biologic rationale is discussed.     

Digital guides to facilitate retained root removal and simultaneous implant placement

The aim of this study was to report the use of digital guides to locate impacted residual roots (IRR) (location guide) and to simultaneously insert dental implants (surgical guide). This case series included five patients. The IRR was first removed through a lateral window approach using the digital location guide, then the implant was placed simultaneously with the implant surgical guide. Definitive restorations were completed after a 6-month healing period. An average of 13.0 ± 3.1 minutes was required to locate the IRR. The implant stability quotient (ISQ) was obtained during surgery and before digital coping using a non-invasive resonance frequency measurement. The average ISQ during surgery for the five dental implants was 60.2 ± 6.3, and the value increased to 66.6 ± 4.8 before final restoration. The average deviations at the implant neck and root apex were 0.48 ± 0.25 mm and 0.74 ± 0.46 mm, respectively. The average angular deviation was 3.5 ± 1.4°. Bone resorption at the implant neck was a mean 0.072 ± 0.041 mm before final restoration. All implants functioned well at 1 year after final restoration. The application of surgical guides in the extraction of IRR enabled crestal bone preservation and simultaneous implant placement.     

Trajectory surgical guide stent for implant placement.

This article describes a new implant placement surgical guide that gives both implant location and trajectory to the surgeon. Radiopaque markers are placed on diagnostic dentures and a lateral cephalometric radiograph is made that shows the osseous anatomy at the symphysis and the anterior tooth location. The ideal implant location and trajectory data are transferred to a surgical stent that programs the angle and location of the fixtures at time of surgery. The stent has the additional benefit of acting as an occlusion rim, a mouth prop, and tongue retractor. Use of this stent has resulted in consistently programming the placement of implant fixtures that are prosthodontically ideal.