Presurgical Radiographic Planning for Dental Implants

Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography

A Position Paper Subcommittee of the American Academy of Oral and Maxillofacial Radiology (AAOMR) reviewed the literature since the original position statement on selection criteria for radiology in dental implantology, published in 2000. All current planar modalities, including intraoral, panoramic, and cephalometric, as well as cone beam computed tomography (CBCT) are discussed, along with radiation dosimetry and anatomy considerations. We provide research-based, consensus-derived clinical guidance for practitioners on the appropriate use of specific imaging modalities in dental implant treatment planning. Specifically, the AAOMR recommends that cross-sectional imaging be used for the assessment of all dental implant sites and that CBCT is the imaging method of choice for gaining this information. This document will be periodically revised to reflect new evidence.

Computer-aided dental implant planning

Computer-aided dental implant planning increases the predictability of replacing missing teeth in partially and fully edentulous cases. This article describes how Nobel Biocare's Procera surgical planning software converts a patient's double CT scan data into a virtual three-dimensional model of the alveolar bone and overlying prosthesis. Using these images, the practitioner virtually places implants in the bone in precise relation to their position in the final prosthesis. Procera uses this virtual plan to fabricate a customized surgical template that guides the placement of the implants safely, precisely, and accurately. Then the dental laboratory can construct the master cast and provisional restoration before surgery, allowing the restoration to be inserted immediately after placement of the implants. Furthermore, computer-based guided implant surgery is minimally invasive and requires a shorter chair time and fewer appointments than traditional methods.

Surgical Planning and Prosthesis Construction Using Computed Tomography, CAD/CAM Technology, and the Internet for Immediate Loading of Dental Implants

This report describes a protocol that uses computer technology and medical imaging to virtually place anterior and posterior dental implants and to construct a precise surgical template and prosthesis, which is connected at the time of implant placement. This procedure drastically reduces patient office time, surgical treatment time, and the degree of post-treatment recovery. Patients with an edentulous arch or a partially edentulous area had a denture with radiopaque markers constructed for computed tomography (CT) scans of the appropriate jaw. The CT images, having acquisition slices of 0.4 mm, are transposed in a three-dimensional image-based program for planning and strategic placement of dental implants. After virtual implant placement on the computer, the surgical treatment plan is sent to a manufacturing facility for construction of the surgical template. The manufactured surgical components and surgical template arrive on the clinical site. From the surgical template, the dental laboratory retro-engineers the master cast, articulates it with the opposing dentition based on a duplicate of the scanning denture, and creates the prosthesis. Using the surgical template, minimally invasive surgery is performed without a flap, and the prosthesis is delivered, achieving immediate functional loading to the implants. Minor occlusal adjustments are made. The total surgical treatment time required is typically between 30 and 60 minutes. Postoperative symptoms such as pain, swelling, and inflammation are dramatically reduced.

CLINICAL SIGNIFICANCE

Identification of the bone in relationship to the tooth position via three-dimensional CT prior to surgery allows the clinician to precisely place implants. Computer-aided design/computer-assisted manufacture technology using the three-dimensional images allows for fabrication of the surgical template. This is a significant advancement in implant dentistry and promotes interdisciplinary approaches to patient treatment. The implant surgeon and restorative dentist can agree upon implant locations and screw access locations prior to the surgical episode.

Interactive imaging for implant planning, placement, and prosthesis construction

PURPOSE

This review describes a new interactive imaging program that allows computed tomography (CT) images to be used to virtually place dental implants and construct a precise guide splint and final prosthesis for delivery at the time of implant placement.

MATERIALS AND METHODS

Patients with edentulous arches were recruited to participate in a trial program to assess the feasibility of using CT images in a 3-dimensional image-based program (Oralim; Medicine NV, Belgium) for planning and placing dental implants. Patients meeting the criteria received a CT of the appropriate arch using a denture with radiopaque markers indexed to the opposing arch. Acquisition slices of 0.6 mm or less was required. The software allowed precise planning for implant placement after which the planned case was sent to a manufacturing facility for splint and prosthesis construction.

RESULTS

The guide splint and final prosthesis were returned to the clinical site for implant placement. An implant map was provided for each patient showing the diameter and length of the implant and abutments to be used in each predetermined implant site. The surgery was accomplished without a flap, and the prosthesis was delivered immediately. Occlusion required only minor adjustments in all cases, and immediate function was accomplished.

CONCLUSION

Interactive computer imaging can allow precise planning for implant position and the images can be used for guide splint and final prosthetic fabrication prior to surgery. This technology is powerful, easy to use, and is a significant advance in implant dentistry.