Fabrication of a radiographic and surgical stent for implants with a vacuum former

Surgical templates for dental implant positioning; current knowledge and clinical perspectives

Dental implants have been used in a variety of different forms for many years. Since the mid-20^th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.

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.

Types of Implant Surgical Guides in Dentistry: A Review

Various techniques have been proposed for the fabrication of surgical guide templates in implant dentistry. The objective of this paper is to review the associated literature and recent advancements in this field, based on design concept. An electronic and hand search of the literature revealed 3 categories, namely, nonlimiting, partially limiting, and completely limiting design. Most clinicians still adopt the partially limiting design due to its cost-effectiveness and credibility. Moreover, clinicians use cross-sectional imaging during the preimplant assessment of surgical sites.

Presurgical planning in implant restorations: correct interpretation of cone-beam computed tomography for improved imaging

Contemporary implant dentistry is a primarily prosthetically driven treatment. The implant position is defined during the diagnostic phase, and the radiographic guide (template) indicates accurately the area of concern on the cone-beam computed tomography (CBCT). CBCT is an essential diagnostic key to a successful treatment plan in many cases. The aim of this paper was to underline the importance of proper alignment of the scanning levels in CBCT in order to avoid distorted cross-sectional images. As demonstrated with two clinical cases in this preliminary study, the initial scanning images of the CBCT must be drawn parallel to the occlusal plane, as defined by the diagnostic wax-up of the final restoration. The radiographic template offers valuable information about the planned location and inclination of the implant and the restoration. Proper image reconstruction following the dental scan can contribute significantly to accurate cross-sectional images and detailed presurgical planning.

Role of surgical stents in determining the position of implants

AIM

Demand from implant patients for quality and efficient treatment is increasing. Fortunately dental implant treatment is evolving with patients expectations.

MATERIALS AND METHODS

The study comprised of 45 patients for whom 89 implants were placed at different sites. Efficacy of the stents is evaluated in determining the position and diameter of the implants.

CONCLUSION

this study shows the extreme accuracy of this surgical stents in implant installation in terms of position and diameter.

Implant surgical guide fabrication for partially edentulous patients

This article presents an innovative method for the fabrication of implant drill guides for partially edentulous patients. Using a light-polymerized composite material and drill blanks placed in the prosthodontically driven implant position, surgical guides for each implant drill are constructed on the diagnostic cast. In addition to the size-customized implant surgical guides, a ridge crest preparation guide showing the proposed crown contour is used to adjust the tissue contour, if needed, during implant surgery.

Effects of varied dimensions of surgical guides on implant angulations

STATEMENT OF PROBLEM

Fabrication of a proper surgical guide is critical for success of implant restorations. The effects of the dimensional factors of the surgical guide on implant placement have not been studied.

PURPOSE

The purpose of this study was to determine the effect of varied dimensions (diameter, length, and distance between the underside of the surgical guide and the implant recipient site) of a surgical guide on the accuracy of implant angulation.

MATERIAL AND METHODS

In this in vitro study, 240 implant recipient sites were randomly prepared using varied dimensions of a surgical guide. The varied dimensions of the surgical guide's channel and distance were: channel diameter (2, 3, 4, or 5 mm), channel length (6 or 9 mm), and distance between the underside of the surgical guide and the simulated implant recipient site (2 or 4 mm). From these varying dimensions and distances, 16 combinations of dimensions and distances were tested. For each combination, 15 simulated implant recipient site (SIRS) specimens were prepared. The deviated angulation (DA) from the midpoint of the top surface of the 1- x 1-inch simulated implant recipient site (each simulated implant recipient acrylic block contained 5 SIRS of 1 x 1 inch), in the right-to-left (DA(RL)) and front-to-back (DA(FB)) directions, were measured in degrees using a protractor. The data was analyzed using factorial analysis of variance and Tukey's HSD test (alpha=.05).

RESULTS

The DA(RL) , in degrees, at a channel length of 9.0 mm (2.33 +/- 1.27) was significantly smaller than at a channel length of 6.0 mm (3.0 +/- 1.42, P =.0001). The DA(RL) , in degrees, at a distance of 4.0 mm (2.13 +/- 1.16) was significantly smaller than at a distance of 2.0 mm (3.16 +/- 1.39, P =.0001). Also, a significant interaction for DA(RL) was found between diameter and distance ( P <.05). For DA(FB) , the varying diameters ( P <.05), lengths ( P =.0001), and distances ( P =.0001) showed significant differences. The DA(FB) at a channel length of 9.0 mm (2.56 degrees +/- 1.51) was significantly smaller than that at 6.0 mm (3.82 degrees +/- 1.87). Significant interactions found for DA(FB) were: diameter by length ( P =.0001), diameter by distance (F=4.547, P =.004), and length by distance (F=11.512, P =.001).

CONCLUSION

Within the limitations of this study, the results suggest channel length as the primary controlling factor in minimizing deviated angulations.