Implant surgical guide fabrication for partially edentulous patients

Integration of conventional and digital surgical guide fabrication techniques for the partially edentulous patient: Reducing the number of surgical procedures for a complete arch implant-supported prosthesis

Surgical procedures on partially edentulous patients for complete arch implant-supported prostheses involve remaining tooth extraction, alveolar bone reduction, and implant placement. Traditionally, partially edentulous patients undergo multiple surgeries, which extends the healing time and results in an extensively prolonged total treatment timeline. This technical article focuses on the fabrication of a more stable and predictive surgical guide to perform multiple surgical procedures in a single surgical appointment and planning a complete arch implant-supported prosthesis for the partially edentulous patient.

An evaluation of virtually planned and 3D-printed stereolithographic surgical guides from CBCT and digital scans: An in vitro study

STATEMENT OF PROBLEM

The process of manufacturing stereolithographic surgical guides for static computer-guided implant placement involves a series of steps. Errors can be incorporated in various forms and at various stages of manufacturing these guides. Errors introduced during this process have not been fully investigated.

PURPOSE

The purpose of this in vitro study was to assess the errors introduced during the manufacture of stereolithographic surgical guides generated from cone beam computed tomography (CBCT) and digital scans by using a virtual implant planning software.

MATERIAL AND METHODS

Ten stereolithographic surgical guides with the associated standard tessellation language (STL) files of their virtual design were used in this study. The STL files of the virtual design and the scans of the stereolithographic surgical guides were superimposed. Linear deviation at the center of the sleeve top and sleeve base and the angular deviation at the center of the sleeve were measured.

RESULTS

The minimum and maximum linear deviation at the center of the sleeve top and the sleeve base was found to be 0 and 40 μm, with less linear deviation observed at the center of the sleeve top (mean ±standard deviation 18 ±7 μm) than at the center of the sleeve base (20 ±7 μm). The minimum and maximum angular deviation at the center of the sleeve was found to be 0 degrees and 5.9 degrees respectively, with a mean ± standard deviation of 1.36 ±0.74 degrees.

CONCLUSIONS

Errors were found in the sleeve position between the virtual design and the stereolithographically manufactured surgical guide. This error may introduce errors in the final implant position.

An Easy Approach for the Fabrication of Surgical Template for Placement of Mini-implant

The success of dental implant depends on meticulous treatment planning. Restorative problems are often common with improper placement of implants, especially where the alveolar bone quantity is compromised. The accuracy needed in placement of the mini-implant is even more. Hence, the use of a surgical guide becomes essential. Various authors have suggested techniques for the fabrication of surgical and radiographic stents. These techniques make use of different materials in fabrication of stent. This article presents a simple technique for the fabrication of a surgical guide for the placement of mini-implants using simple readily available materials. The technique can be modified to be used for regular diameter implants.

Emergence Profile Index Implant Surgical Guide

INTRODUCTION

This case series presents an innovative approach to fabricating an implant surgical guide to facilitate ideal implant placement.

CASE SERIES

Three healthy, non-smoking patients with a partially edentulous ridge presented to a private practice. Informed consent for dental implant placement was attained from patients. Sequential three-dimensional (3D) surgical guides were fabricated before implant surgery using light-polymerizing material. These guides provided information to the surgeons on implant position in the bucco-lingual, mesio-distal, and apico-coronal directions.

CONCLUSION

With assistance of the proposed surgical guide, ideal 3D implant placement can be achieved so that future peri-implant complications can be minimized.

Flexible thermoplastic resin to add retention to tooth-supported stereolithographic surgical guides

Surgical guides produced by stereolithography use hard resin. The hard resin prevents seating beyond the height of contour, hence these guides are not intrinsically retentive. By covering the guide with a flexible thermoplastic material that extends into the undercuts, the resulting guide now has a retentive feature. This allows it to maintain its position during surgery yet it can easily be removed and repositioned.

An adjustable, cast based, fully restrictive surgical guide

The 3D Click Guide is a fully restrictive cast-based surgical guide for the placement of dental implants. This in-office system consists of prefabricated parts that are assembled onto a carrier. The 3-dimensional data are derived from a dental cast in combination with a periapical radiograph or cone-beam computed tomography data.

Designing a custom made gauge device for application in the access hole correction in the dental implant surgical guide

Anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an esthetic outcome. The predictability of success can be increased, if the implants are placed properly. During oral implant placement, the drill must be guided by the surgeon according to the final form of the restoration. A surgical template would be helpful in more accurate placement of the dental implants. Surgical guides fabricated in laboratory are still being used. But these guides often need correction after computed tomography (CT) scan evaluation. For their correction and reducing the possibility of error, a scaled milling machine is usually required. But this scaled milling machine is not available omnipresent. In this article a simple device is described that can be attached to any milling machine and surveyor. The presented device can correct the diagnostic template easily and predicts dental implants placement with more favorable esthetic and occlusal outcome.

An organized start to implant-supported prosthesis

Various treatment options are available for rehabilitating the complete edentulous patients with implants. However, due consideration for the prosthesis is not given prior to implant surgery. This can result in implant being placed in locations that do not provide the best esthetic and functional result. Incorrect implant localization and angle are the primary cause of non-axial loading and may contribute to loss of Osseo-integration. For predictable outcome, the treatment should begin with visualizing the end result. A step-wise pre-implant surgery evaluation is necessary to achieve the objectives. This is a case report of a completely edentulous patient who was treated with fixed implant prosthesis following various steps in the pre-implant surgery evaluation.

Reliability of implant surgical guides based on soft-tissue models

The purpose of this study was to determine the accuracy of implant surgical guides fabricated on diagnostic casts. Guides were fabricated with radiopaque rods representing implant positions. Cone beam computerized tomograms were taken with guides in place. Accuracy was evaluated using software to simulate implant placement. Twenty-two sites (47%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). Soft-tissue models do not always provide sufficient accuracy for fabricating implant surgical guides.

Fabrication of a cast-based implant surgical guide using guide sleeves

A unique method for fabricating cast-based surgical guides is presented. A proposed position and mesiodistal angulation of the implant are verified with periapical radiography and registered with a commercially available guide sleeve. The sleeve is attached to a surgical guide made of light-polymerized acrylic resin. The surgical guide can be used in a broad range of situations and allows for accurate implant placement in a prosthetically driven position with surgical access and visibility, simplicity, and cost efficiency.

Esthetics in implant-supported prostheses: a literature review

Esthetics is important for success of implant-supported prostheses. This study aimed to review esthetics concepts for implant treatment. Research in the PubMed database included studies published from 1995 to 2010 with the keywords implant esthetics, implant-supported prostheses, and esthetics. Forty-five studies were evaluated regarding the presurgical planning, surgical phase, and temporary and final restoration phases. It was concluded that esthetics in implant-supported prostheses results from a multidisciplinary approach from planning until insertion of the final restoration.

Use of diagnostic and surgical stent: a simplified approach for implant placement

Dental implantology has emerged as a practical alternative to traditional prosthodontics. Since the beginning, placement of implant in the bone to achieve a prosthetic solution that fulfils biologic, aesthetic and biomechanical requirements has been a challenge. In the past, implant site and inclination were dictated by residual bone quality. The desire for predictable prosthesis led to the development of prosthetically guided implantology. This concept establishes the correct implant position during the diagnostic stage according to planned definitive restoration. In prosthetically guided implantology where ideal placement of implant is determined by the definitive restoration, use of radiographic and surgical stent in conjunction with dental CT scan can play an important role. A stent is an appliance used for radiographic evaluation during treatment planning for implant placement and during surgical procedures to locate optimal implant placement site. The stent with dental CT scan enables the dental team to identify specific sites of prospective implant surgery and hence determines the optimal position and angulation of implant relative to occlusal load. Aided by stent the surgeon can avoid undesirable implant site preparation and minimize unnecessary osteotomy, resulting in favorable design of prosthesis, reduced surgical trauma, reduced surgical time and increased patient comfort. This case report is an insight into the method of fabrication of simple and cost effective stent for implant placement and its advantages over the other techniques of stent fabrication.

Screw- versus cement-retained implant restorations: current concepts

The debate between screw- versus cement-retained implant prostheses has long been discussed but the best type of implant prosthesis remains controversial among practitioners. An understanding of their properties will help the clinician in selecting the ideal prosthesis for each clinical case while promoting final esthetic outcomes. With the evolving technology and knowledge, an update of the current trends is necessary. This article provides an overview of the different characteristics of screw- and cement-retained implant restorations, and how they may influence the esthetics, retrievability, retention, passivity, occlusion, accessibility, cost, and provisional restorations. Problems and complications frequently encountered are discussed and treatment solutions are proposed.

Loma Linda Guide: A Stereolithographically Designed Surgical Template: Technique Paper

A new flapless technique based on a template fabricated from a stereolithographic maxillary model is presented in this article. The proposed concept can be used to accurately control the tridimensional position of the dental implant. The laboratory procedures involving the fabrication of the surgical template are described.

Cast-based guided implant placement: a novel technique

One of the most challenging aspects of implant placement is the correct spatial positioning of the dental implant in the bone. Surgical guides of various configurations have been proposed to aid implant placement. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes a combination of analog techniques, including bone sounding and periapical radiographs used to study the available bone volume. A simplified casting protocol is proposed, and the implant platform position of the implant analog is transferred to a surgical guide composed of a stiff vinyl polysiloxane material. This surgical guide is used in a conventional flapless guided implant surgery protocol. This combination of techniques allows precise placement of a dental implant, abutment, and provisional restoration in a minimally invasive manner.

Screw versus cemented implant supported restorations

Implant supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws. Screw retained implant restorations are the authors' preferred method of securing restorations to implants. This article will be written from this perspective and the advantages and disadvantages of each method of retention will be discussed under the following headings: Aesthetics, Retrievability, Retention, Implant placement, Passivity, Provisionals, Occlusion, Immediate loading, Impression procedures, Long term treatment planning.

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.

Effect of Flapless Implant Surgery on Soft Tissue Profile: A Randomized Controlled Clinical Trial

BACKGROUND

Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics.

METHODS

Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery. Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plaque index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months.

RESULTS

The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P <0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P >0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P >0.05).

CONCLUSIONS

The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single-tooth implants either immediately or delayed loaded. Other long-term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study.