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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 23-26

Custom-made Tool for Parallel Placement of Implants


1 Private Practitioner, Bliss Dental Care, Jaipur, Rajasthan, India
2 Department of Prosthodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Date of Web Publication5-Mar-2018

Correspondence Address:
Himanshu Pal
Bliss Dental Care, S-9, Bhaskar Enclave, Next To SBI, Patrakar Colony, Mansarovar, Jaipur - 302 020, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_81_17

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   Abstract 


Parallel placement of dental implants is an accepted surgical and prosthodontic norm when multiple implants are used. Use of paralleling pins supplied with the implant kit is an arbitrary method. An instrument is designed that helps in maintaining the parallelism between implants intraorally. The instrument consists of a horizontal plate with millimeter graduation. A slot is created in the horizontal plate to house a vertical rod. The vertical rod can move mesiodistally as well as occlusogingivally. It must be ensured that the vertical rod is exactly parallel to the long axis of the drill in all the directions. The horizontal plate is then securely attached to the handpiece. After the first osteotomy is made, the vertical rod is placed in the site. The position of vertical rod will guide the second drill parallel to the osteotomy site. This instrument will guide us to correctly determine the inter implant distance, and also depth of the preparation. The instrument is autoclavable.

Keywords: Guide tool; parallel implants; tool for implant placement


How to cite this article:
Pal H, Nair K C, Hegde D. Custom-made Tool for Parallel Placement of Implants. J Interdiscip Dentistry 2018;8:23-6

How to cite this URL:
Pal H, Nair K C, Hegde D. Custom-made Tool for Parallel Placement of Implants. J Interdiscip Dentistry [serial online] 2018 [cited 2020 Nov 26];8:23-6. Available from: https://www.jidonline.com/text.asp?2018/8/1/23/226641




   Clinical Relevance to Interdisciplinary Dentistry Top


Certain clinical situation demands placement of implants parallel to each other. An attempt to place implants parallel to each other arbitrarily may not produce desired results. Guide tools available in the market with various implant systems are expensive and have to be procured separately. Authors in this study have designed a tool that can guide in placing the implants parallel to each other, and is easy to fabricate as well as cost effective.


   Introduction Top


Transmission of masticatory load through the implant to the supporting bone within physiologic parameters dictates the success of implant treatment. Unfavorable concentration of stress results in resorption of bone and eventually the failure of implant.[1] Vertical loading applied on an angled abutment is a classic example of untoward stress concentration.[2] Stress-induced damage to the bone attains undesirable proportions when more than one implant is splinted, especially when the implants are not placed in a mutually parallel position.[3] More than the predictable control of stresses, parallel placement of implants favors esthetics.[4],[5] Various tools have been designed to place the implants in the correct and desired position. Customized radiographic surgical template and computer-designed template are tools that guide in the placement of the implants. Parallel placement is achieved by the pins supplied along with the implant kit, but the result is quite arbitrary. In any attempt to correct wrongly angulated osteotomy, one may end up creating a larger osteotomy site than that is required. Paralleling guide kits are available in the market, but they have to be procured separately and are expensive. Hence, it was decided to design a less expensive instrument that would enable parallel placement of implants. The design and structural details of the instrument are presented in this article.

Instrument design

The instrument consisted of a horizontal plate with millimeter graduation. The horizontal plate had sufficient strength to resist flexion during the usage. A slot was created in the plate to house an acrylic holder and a vertical rod [Figure 1]. Vertical rods with different diameters could be used to match the standard osteotomy sites created. The vertical rod could be moved mesiodistally as well as occlusogingivally. This movement of vertical rod helps in determining the interimplant distance and the placement of the implant. Before attaching the instrument to the handpiece, the most distal osteotomy site is prepared. After the preparation of the first osteotomy site, the paralleling instrument is secured to the handpiece. Both the vertical rod and the drill are positioned mutually parallel. A vertical rod is then engaged in the first osteotomy site [Figure 2]. The position of the vertical rod guides the drill parallel to the first osteotomy site and the second osteotomy was performed [Figure 3]. Millimeter graduations on the plate guide the operator in determining the interimplant distance. The paralleling instrument is cleansable and autoclavable. It can be fabricated economically.
Figure 1: Designed instrument

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Figure 2: Vertical rod in the distal osteotomy

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Figure 3: Final position

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   Case Report Top


A 37-year-old female patient with no contributory medical history reported for the replacement of missing teeth. The patient had a Kennedy's class I maxillary arch and Kennedy's class II modification 2 mandibular arch. The patient was informed of the various treatment options, namely removable partial denture and implant-retained fixed restoration. The patient opted for implant-retained fixed treatment. Implants of size 4.5 mm × 10 mm (Neo CMI Implant systems, Korea) were selected for the left mandibular arch of the patient. After making the pilot drill, the instrument was attached to the handpiece [Figure 4]. After securing the vertical rod parallel to the drill, the osteotomies were performed [Figure 5] and [Figure 6]. The postoperative radiograph of the patient confirmed parallel placement of implants in the 46 and 47 regions [Figure 7] and [Figure 8].
Figure 4: Instrument secured to the handpiece

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Figure 5: Vertical rod in the osteotomy site

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Figure 6: Position verified with paralleling pins

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Figure 7: Preoperative radiograph

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Figure 8: Postoperative radiograph

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   Discussion Top


During the initial stages of implant treatment, a major concern was the availability of bone rather than the design of the prosthesis. This has resulted in arbitrary placement of implants, subsequently resulting in failures. Surgical guides have optimized the implant treatment to a great extent.[6] Templates integrated with metal spheres or rods, sleeves, and guide posts have enhanced the level of accuracy. Surgical templates are fabricated on dental casts and ensure only positional accuracy, but are greatly limited by the fact that soft-tissue resiliency factor and bone topographical details are lacking.[7],[8] Moreover, anatomical landmarks are not precisely located in the cast. To overcome the limitations associated with conventional radiographic surgical template, computer-generated surgical templates have been evolved.[9] This is made by stereolithographic process and is custom fabricated for each patient. Fabrication of stereolithographic templates requires patient's computed tomography image. Exclusively designed software allows the patient to virtually view the implant site and thereby plan the location, angle, depth, and diameter of the virtual implants. These virtual images can be superimposed on the three-dimensional data. The guides fabricated by this technique are accurate, but this requires complex planning and an expensive setup.

The presently designed instrument is convenient to use as it requires only conventional planning and instrumentation. The plate with millimeter graduations, the vertical rod, and the holder can be fabricated using locally available materials. The instrument is attached to the handpiece after the most distal osteotomy site is prepared. Achieving parallelism between the rod and the drill is a simple process. A vertical rod is then engaged in the first osteotomy site. The vertical rod serves as a guide while operating with the handpiece. The paralleling instrument is cleansable and autoclavable.


   Conclusions Top


The custom-fabricated instrument for parallel placement of implants is convenient to use and easy to assemble. It does not require complex planning and instrumentation. It is easy to clean and sterilize. The instrument can be integrated to any of the presently used handpieces.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ueda C, Markarian RA, Sendyk CL, Laganá DC. Photoelastic analysis of stress distribution on parallel and angled implants after installation of fixed prostheses. Braz Oral Res 2004;18:45-52.  Back to cited text no. 1
    
2.
Glantz PO, Rangert B, Svensson A, Stafford GD, Arnvidarson B, Randow K, et al. On clinical loading of osseointegrated implants. A methodological and clinical study. Clin Oral Implants Res 1993;4:99-105.  Back to cited text no. 2
    
3.
Kohn DH. Overview of factors important in implant design. J Oral Implantol 1992;18:204-19.  Back to cited text no. 3
    
4.
Canay S, Hersek N, Akpinar I, Aşik Z. Comparison of stress distribution around vertical and angled implants with finite-element analysis. Quintessence Int 1996;27:591-8.  Back to cited text no. 4
    
5.
Brosh T, Pilo R, Sudai D. The influence of abutment angulation on strains and stresses along the implant/bone interface: Comparison between two experimental techniques. J Prosthet Dent 1998;79:328-34.  Back to cited text no. 5
    
6.
Ramasamy M, Giri, Raja R, Subramonian, Karthik, Narendrakumar R. Implant surgical guides: From the past to the present. J Pharm Bioallied Sci 2013;5:S98 102  Back to cited text no. 6
    
7.
Brief J, Edinger D, Hassfeld S, Eggers G. Accuracy of image-guided implantology. Clin Oral Implants Res 2005;16:495-501.  Back to cited text no. 7
    
8.
Lal K, White GS, Morea DN, Wright RF. Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part I. The concept. J Prosthodont 2006;15:51-8.  Back to cited text no. 8
    
9.
Widmann G, Bale RJ. Accuracy in computer-aided implant surgery – A review. Int J Oral Maxillofac Implants 2006;21:305-13.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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