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SHORT COMMUNICATION
Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 132-134

Guided surgery for a simple and predictable implant placement


1 Department of Prosthodontics, Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bengaluru, India
2 Department of Prosthodontics, AECS Maaruti College of Dental Sciences and Research Center, Kammanahalli, Bengaluru, India
3 Department of Prosthodontics, S. B. Patil Dental College and Hospital, Naubad, Bidar, Karnataka, India

Date of Web Publication4-Sep-2012

Correspondence Address:
Venkateswara Allu Reddy
Department of Prosthodontics, Vydehi Institute of Dental Sciences and Research Centre, Whitefield, Bengaluru
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.100608

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   Abstract 

The dental implant procedure has a long and proven track record to be one of the most predictable in terms of treatment outcome. This procedure has integrated itself as a part of routine treatment plans in dental offices because of increasing popularity and patient acceptance. In order to uphold this success, optimum diagnosis and treatment planning is crucial. Hence, computerized tomography aided imaging and template-guided surgery plays an important role in pre-placement planning and helps ensure positive outcomes. This article describes the benefits of computer-guided surgery as compared with conventional implant placement procedures, along with a case report.
Clinical Relevance to Interdisciplinary Dentistry

  1. Implant therapy requires a multidisciplinary approach.
  2. The prosthodontist needs to plan the situation with the end prosthesis in mind.
  3. The periodontist needs to preserve the already compromised bone.
  4. The surgeon needs to navigate the implant into critical areas.

Keywords: CT surgical guide, flapless surgery, guided surgery


How to cite this article:
Reddy VA, Reddy V, Reddy Gade CK. Guided surgery for a simple and predictable implant placement. J Interdiscip Dentistry 2012;2:132-4

How to cite this URL:
Reddy VA, Reddy V, Reddy Gade CK. Guided surgery for a simple and predictable implant placement. J Interdiscip Dentistry [serial online] 2012 [cited 2019 Sep 21];2:132-4. Available from: http://www.jidonline.com/text.asp?2012/2/2/132/100608


   Introduction Top


In order to make a surgical technique simple and predictable, 3D information from tomography or computerized tomography (CT) scans is teamed with a particular software that provides us with a virtual model of the jaw. This helps in virtual planning and generation of a surgical guide, which in turn aids in the placement of implants into ideal positions based on the local topography and final prosthetic outcome.


   Case Report Top


A male patient aged 67 years complained of difficulty in chewing due to loss of posterior teeth on one side for the past 20 years. His attempts at wearing removable partial dentures were unsuccessful because of discomfort. His previous dentist had ruled out the possibility of fixed restorations due to periodontally compromised adjacent teeth. He had been told that implants were ruled out as well, due to insufficient bone. The patient stated that effective restoration of mastication was his prime concern.

A complete oral examination followed by detailed medical and dental history was recorded [Figure 1]. The patient was a known hypertensive and diabetic, for which he was on adequate medication. Edentulous ridge corresponding to missing 34-36 had significant horizontal and vertical bone deficiency. Intraoral measurement of the width of the ridge was found to be on an average of 6.5 mm, when measured with a tissue caliper.
Figure 1: Intraoral pre-op and post-op

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Radiographic assessment from orthopantomogram (OPG) [Figure 2] revealed that the available bone height was no more than 9 mm from the crest of the ridge to the mandibular canal, which was reconfirmed as 8.5 mm from CT scan.
Figure 2: OPG pre-op and post-op

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The biggest challenge was not only the insufficient height of the bone due to the location of the mandibular canal, but also the unpredictable anterior loop of the mandibular nerve in the region of the premolar and the submandibular fossa in the molar region.

Keeping the dimensions of bone, medical history, and the patient's willingness to bear the cost, it was decided to restore the edentulous space with implants using computer-guided surgery to increase predictability and minimize post-surgical complications.

A radiographic guide was fabricated by modifying the existing partial denture with six radiographic positioning points. The patient was expected to wear this radiographic guide at the time of CT scan procedure. Two scans were made, one with the patient wearing the guide and the other only of the guide. The obtained data was stored in DICOM format. The guide was placed in the patient's mouth, a pick-up impression made, and a model poured. This model and the DICOM format file were sent to the scanning and milling center for virtual planning. The surgical guide was then prepared based on the virtual planning [Figure 3].
Figure 3: Surgical guide and virtual planning

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The surgery was carried out using local anesthesia. The computer-generated surgical guide was put in place and a punch incision was made in relation to 34 and 36 region. Osteotomy site was prepared. Two implants of dimension 4.2 × 8 mm standard platform were placed in the region of 34 and 36, respectively. After placement, a check X-ray was taken and healing abutments were placed.

The procedure was quick, painless, atraumatic, and predictable. There were no postoperative complications.

After 3 months, the final Porcelain fused to metal restoration was fabricated and cemented with non-eugenol temporary cement (Tempbond NE, Kerr, CA, USA)


   Discussion Top


The developments of guided surgery in oral implantology have been driven by many factors. To state a few, they are:

  1. A minimally invasive approach to surgery/flapless surgeries that reduce postoperative pain and swelling. [1]
  2. Precision in esthetic zones. [2]
  3. Avoiding the second stage surgery.
Studies have been conducted on evaluating the accuracy of implant placement using an integrated system of guidance. Dreiseidler found crestal deviations of 217 microns ± 99 microns and apical deviations 343 microns ± 146 microns when comparing planned and actual placements on partially edentulous models. [3]

Guided surgery requires a multidisciplinary approach to implant treatment. Though it is a prosthetically driven discipline, the role of various specialists is invaluable in radiographic assessment and planning, executing the minimally invasive surgical protocol, and fabrication of esthetically pleasing and functionally viable restorations.

Thus, it can be effectively concluded that there is ample scope for usage of computer-guided surgeries and templates in a myriad of situations, but by no means is this a substitute for the skill of the surgeon and periodontist, or planning by the prosthodontist. It is safe to say that that computer-guided surgeries with a surgical guide act as "a facilitator, not a crutch."

 
   References Top

1.Abad-Gallegos M, Gómez-Santos L, Sánchez-Garcés MA, Piñera-Penalva M, Freixes-Gil J, Castro-García A, et al. Complications of guided surgery and immediate loading in oral implantology: A report of 12 cases. Med Oral Patol Oral Cir Bucal 2011;16: E220-4.  Back to cited text no. 1
    
2.Levin BP. Using computer-guided implant surgery to achieve predictable treatment outcomes. Inside Dentistry. AEGIS Publications LLC, May; 2011.  Back to cited text no. 2
    
3.Dreiseidler T, Neugebauer J, Ritter L, Lingohr T, Rothamel D, Mischkowski RA, et al. Accuracy of a newly developed integrated system for dental implant planning. Clin Oral Implants Res 2009;20:1191-9.  Back to cited text no. 3
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