Computer Guided Implantology Overview
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Questions and Answers

What are the three main departments that share in computed guided implantology?

Surgery, Radiology, Fixed Prosthodontics

What is the main benefit of a cast-based surgical guide?

Determining the point of entry

The paradigm shift in Implantology moved from 3D to 2D imaging.

False (B)

What are the advantages of using 3D imaging over 2D imaging in implantology?

<p>Better planning, improved representation of the 3rd dimension, reduced risk of implant placement complications, free of shape distortion, minimal size distortion, more accurate measurements.</p> Signup and view all the answers

The use of 3D imaging requires a steeper learning curve compared to 2D imaging.

<p>True (A)</p> Signup and view all the answers

Computed guided implantology has moved from prosthetically driven to surgically driven placement.

<p>False (B)</p> Signup and view all the answers

The implementation of computer-guided implantology has dramatically increased costs.

<p>True (A)</p> Signup and view all the answers

What are the functions of a surgical guide?

<p>Determine the point of entry, control the direction and length of drilling, maintain parallelism</p> Signup and view all the answers

What are the advantages of using a flapless surgical approach?

<p>Less required surgical skills (A), Decreased post-operative edema (B), Decreased post-operative pain (C), Decreased initial bone resorption (D), Decreased chairside time (E)</p> Signup and view all the answers

Which of the following are advantages of pre-operative planning?

<p>High biological outcome (A), High functional outcome (B), Predictable outcome (C), High esthetic outcome (D)</p> Signup and view all the answers

What are the steps involved in computer-guided implant placement?

<p>CBCT or MSCT scanning, treatment planning, surgical guide designing, surgical guide fabrication, surgery performing</p> Signup and view all the answers

Treatment planning and surgical guide designing can be done separately or integrated into a single software.

<p>True (A)</p> Signup and view all the answers

Which scanning technique offers a lower radiation dose?

<p>CBCT (A)</p> Signup and view all the answers

Which scanning technique offers a better contrast resolution, especially for soft tissues?

<p>MSCT (B)</p> Signup and view all the answers

The main factor influencing spatial resolution in CBCT scanning is the voxel size.

<p>True (A)</p> Signup and view all the answers

CBCT scanning provides quantitative values for bone density.

<p>False (B)</p> Signup and view all the answers

What is the range of voxel sizes commonly used in CBCT scanning for implant placement?

<p>0.075 mm to 0.4 mm</p> Signup and view all the answers

What are the two main problems associated with a large field of view in CBCT scanning?

<p>Ethical and legal concerns, increased radiation exposure to the patient</p> Signup and view all the answers

In computer-guided surgery, it is crucial to capture the entire arch, even if the patient only has a single implant, to stabilize the surgical guide.

<p>True (A)</p> Signup and view all the answers

What are the CBCT scan requirements for surgical guide fabrication?

<p>Opposing arch must be visible, two arches must be separated, metal artifacts must be eliminated, noise must be eliminated, area of interest must be covered.</p> Signup and view all the answers

What information can be obtained from a CBCT scan for treatment planning?

<p>Whether an implant is needed, whether a graft is needed, whether a sinus lift is needed, time of implantation (immediate or delayed), whether the implant is fixed or removable, implant length and diameter, number and distribution of implants, cervico-apical position of the implant, angulation of the implant</p> Signup and view all the answers

When is an immediate implant not preferable?

<p>When there is a risk of infection. (A)</p> Signup and view all the answers

A fixed implant is preferred when there is limited bone available.

<p>False (B)</p> Signup and view all the answers

What are the different display modes used in computer-guided implantology?

<p>Multiplanar reconstruction (orthogonal), oblique multiplanar reconstruction (axial, coronal, sagittal), panoramic with serial cross-section, volume rendering</p> Signup and view all the answers

Multiplanar reconstruction (orthogonal) is commonly used in implant planning.

<p>False (B)</p> Signup and view all the answers

Which display mode is best for obtaining an overall view of the anatomical structures?

<p>Panoramic with Serial Cross-Section (A)</p> Signup and view all the answers

Oblique multiplanar reconstruction provides more accurate measurements compared to panoramic with serial cross-section.

<p>True (A)</p> Signup and view all the answers

What is the importance of accurate measurements in implant planning?

<p>Accurate measurements are essential for precise implant placement to ensure adequate bone support, optimal implant angulation, and a successful outcome.</p> Signup and view all the answers

What are the different planes used in oblique multiplanar reconstruction?

<p>Coronal plane, sagittal plane</p> Signup and view all the answers

What are the three types of surgical guides?

<p>Teeth supported, mucosa supported, bone supported</p> Signup and view all the answers

When are teeth supported surgical guides commonly used?

<p>They are used for partially edentulous patients, where at least three healthy teeth are present in the arch.</p> Signup and view all the answers

What are mucosa supported surgical guides used for?

<p>These guides are used for completely edentulous patients or patients with less than three healthy teeth available.</p> Signup and view all the answers

When are bone supported surgical guides used?

<p>They are used for completely edentulous or partially edentulous patients with long spans of edentulism.</p> Signup and view all the answers

What are the different levels of computer-guided implantology?

<p>Level 1: CBCT extracted information, Level 2: Implant Simulation, Level 3: Surgical Guide usage, Level 4: Implant navigation</p> Signup and view all the answers

Which level is associated with implant simulation?

<p>Level 2 (B)</p> Signup and view all the answers

Which level involves the use of a surgical guide?

<p>Level 3 (A)</p> Signup and view all the answers

Which level encompasses implant navigation?

<p>Level 4 (B)</p> Signup and view all the answers

CBCT extracted information includes bone morphology and angulation.

<p>True (A)</p> Signup and view all the answers

Implant simulation involves verifying that the implant fits within the bone completely.

<p>True (A)</p> Signup and view all the answers

A surgical guide is designed and fabricated in Level 3.

<p>True (A)</p> Signup and view all the answers

A vacuum-based scanning appliance is used for patients with few missing teeth.

<p>False (B)</p> Signup and view all the answers

For patients with a fully edentulous arch, a denture-based scanning appliance is used.

<p>True (A)</p> Signup and view all the answers

A properly fitting denture with radio-opaque markers is crucial for accurate scanning.

<p>True (A)</p> Signup and view all the answers

What are the requirements for designing surgical guides?

<p>All of the above (D)</p> Signup and view all the answers

A single CBCT scan is sufficient for designing surgical guides in all cases.

<p>False (B)</p> Signup and view all the answers

CBCT scanning is effective in differentiating between soft tissues and metallic restorations.

<p>False (B)</p> Signup and view all the answers

Extra-oral or intra-oral scans are recommended for patients with metallic restorations to minimize artifacts.

<p>True (A)</p> Signup and view all the answers

A separate CBCT scan for the patient and the denture alone is recommended for completely edentulous patients.

<p>True (A)</p> Signup and view all the answers

The poor contrast resolution of CBCT scanning makes it challenging to differentiate between the denture and the patient's soft tissue.

<p>True (A)</p> Signup and view all the answers

Dual scans, both with and without the denture, are recommended for partially edentulous patients.

<p>False (B)</p> Signup and view all the answers

A separate CBCT scan is not required for teeth that are not included in the surgical guide.

<p>True (A)</p> Signup and view all the answers

In completely edentulous patients, it is crucial to fabricate the denture before taking a CBCT scan.

<p>True (A)</p> Signup and view all the answers

Radio-opaque markers are placed buccally or lingually on the denture.

<p>True (A)</p> Signup and view all the answers

It is recommended to place radio-opaque markers occlusally on the denture.

<p>False (B)</p> Signup and view all the answers

Placing radio-opaque markers on the denture can create problems during the CBCT scan.

<p>False (B)</p> Signup and view all the answers

The software can superimpose the CBCT image of the patient with the denture scan, allowing for a more accurate surgical guide.

<p>True (A)</p> Signup and view all the answers

The arches must be separated using cotton rolls during CBCT scanning.

<p>True (A)</p> Signup and view all the answers

What are the various technologies used for surgical guide fabrication?

<p>Rapid prototyping, 3D printing, stereolithographic STL file, subtractive, additive</p> Signup and view all the answers

Rapid prototyping involves creating a physical model directly from a digital design.

<p>True (A)</p> Signup and view all the answers

Subtractive fabrication involves adding layers of material to create a 3D object.

<p>False (B)</p> Signup and view all the answers

Which fabrication method is primarily used for surgical guide creation in current practice?

<p>Additive (A)</p> Signup and view all the answers

Stereolithographic 3D printing utilizes a liquid resin material for fabrication.

<p>True (A)</p> Signup and view all the answers

Subtractive fabrication has the advantage of minimal material waste.

<p>False (B)</p> Signup and view all the answers

Subtractive fabrication is well-suited for handling undercuts in surgical guide creation.

<p>False (B)</p> Signup and view all the answers

The STL file is the standard file format used by 3D printers.

<p>True (A)</p> Signup and view all the answers

What are the two files needed for surgical guide fabrication?

<p>DICOM file from CBCT, STL file</p> Signup and view all the answers

What are the two main steps involved in obtaining a surgical guide?

<p>Create an STL file using implant planning software, fabricate the surgical guide using a 3D printer</p> Signup and view all the answers

The software used to create the STL file is the only requirement for obtaining a surgical guide.

<p>False (B)</p> Signup and view all the answers

How can you fix the surgical guide template during surgery?

<p>Using screws, fixing pins</p> Signup and view all the answers

What type of fixing pins are used for mucosa supported guides?

<p>Anchor pins (A)</p> Signup and view all the answers

Partially guided surgery is considered fully guided only if the implant placement is done with the surgical guide present in the patient's mouth.

<p>True (A)</p> Signup and view all the answers

Keys are used to stabilize the drills inside the surgical guide.

<p>True (A)</p> Signup and view all the answers

The surgical kit includes a 3D printer.

<p>False (B)</p> Signup and view all the answers

What are the limitations of surgical guides?

<p>Limited visibility, irrigation difficulties, limited mouth opening</p> Signup and view all the answers

Modified surgical guides (C-style) have been introduced to address the limitations of visibility and mouth opening.

<p>True (A)</p> Signup and view all the answers

What are the disadvantages of using surgical guides?

<p>Complications during surgery (fracture or unfitting), difficult to use, increased costs, accuracy concerns.</p> Signup and view all the answers

The major concern regarding accuracy in a surgical guide approach arises from the fact that surgeons are working blindly.

<p>True (A)</p> Signup and view all the answers

Flashcards

Computer Guided Implantology

A method of placing dental implants using a digitally fabricated surgical template for precision and accuracy in guiding drilling and implant placement.

Surgical Template

A surgical template fabricated using digital data, which guides implant placement during surgery.

Cone Beam Computed Tomography (CBCT)

A medical imaging technique that uses X-rays to create cross-sectional images of the jawbone, providing detailed information about bone density, structure, and anatomy. Commonly used in implant planning.

Multislice Computed Tomography (MSCT)

A medical imaging technique that uses X-rays to create cross-sectional images, providing detailed information about soft tissues and bone density. Offers better contrast resolution compared to CBCT.

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Treatment Planning

The process of digitally planning the implant placement, considering factors like bone density, implant length, diameter, and angulation.

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Surgical Guide Design

A digital representation of the surgical template, created using specialized software based on CBCT scans and treatment planning.

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Surgical Guide Fabrication

The process of physically creating the surgical template from the digitally designed model, using 3D printing or milling techniques.

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Surgery Performing

The actual surgical procedure where the implant is placed using the fabricated surgical template to guide drill placement and ensure precise implant positioning.

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Field of View (FOV)

The area covered by the CBCT scan, which can be adjusted to capture the specific region of interest. It is crucial to balance capturing the entire arch while minimizing unnecessary radiation exposure.

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Voxel Size

The size of the individual pixels in the CBCT scan, which determines the image clarity and detail. Smaller voxel size results in higher resolution.

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Scanning Appliance

A special appliance used during CBCT scanning to help stabilize the patient's jaw and ensure accurate positioning, particularly for patients with missing teeth or dentures.

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Teeth Supported Surgical Guide

A surgical template that uses existing teeth as support for its stability. Suitable for partially edentulous patients.

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Mucosa Supported Surgical Guide

A surgical template that relies on the soft tissues of the mouth for its support. Used in completely edentulous patients or those with limited remaining teeth.

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Bone Supported Surgical Guide

A surgical template that is directly attached to the bone, providing a very stable platform for implant placement. Commonly used in patients with significant bone loss.

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Implant Simulation

A method of digitally simulating implant placement within the patient's jawbone before physically placing the implants. Used for planning and assessing implant feasibility.

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Information obtained from CBCT

The process of analyzing and interpreting information from CBCT scans to determine the presence of teeth, bone grafts, sinus lift requirements, potential complications, and suitable implant locations.

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Panoramic Radiography

A 2D imaging technique that provides a panoramic view of the teeth, useful for assessing the overall dental arch and identifying areas of bone loss

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Multiplanar Reconstruction

A technique used to display the CBCT data in multiple planes, allowing for the analysis of the jawbone from different angles, such as axial (horizontal), coronal (frontal), and sagittal (sideways).

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Volume Rendering

A 3D rendering technique that creates a realistic image of the jawbone based on CBCT data, helping to visualize and assess implant placement and potential complications.

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Fixing Screws

Small screws that are used to secure the surgical guide to the patient's jawbone, preventing it from moving during the implant placement procedure.

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Fixing Pins

Small, removable pins used to help align the surgical guide to the patient's jawbone, ensuring precise positioning during implant placement.

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Partially Guided Surgery

A type of surgical guide that allows only partial guidance during implant drilling. The guide may not cover the full length of the implant or its entire circumference.

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Fully Guided Surgery

A type of surgical guide that provides complete guidance for implant drilling and placement. The guide covers the entire implant length and circumference, offering precise control.

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Keys

Special instruments used within the surgical guide to help stabilize and guide drilling instruments, ensuring accurate and precise placement of the implant.

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Modified Surgical Guide (C-Style)

A modified design of surgical guide that accommodates limited mouth opening and improves visibility and irrigation during the implant placement procedure.

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STL File

A 3 dimensional file format used for storing and exchanging digital models for 3D printing. It's commonly used in the creation of surgical guides.

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Software for Surgical Guide Design

A specialized software program used to design and fabricate a surgical guide based on CBCT scans and treatment planning data.

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3D Printing

A method of manufacturing physical objects from digital designs, using additive processes like 3D printing. Commonly used for surgical guide fabrication

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DICOM File

A digital platform that allows for the transmission of medical images between different devices, such as CBCT scanners, dental software, and 3D printers.

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Milling

A computer-aided design and manufacturing (CAD/CAM) technology that allows the fabrication of surgical guides using a milling machine. It involves removing material from a solid block to create the desired design.

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Rapid Prototyping

A method of creating a physical model from a digital design by using a computer-controlled machine to cut away material from a solid block.

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Unfitted Surgical Guide

A situation where the surgical guide does not properly fit the patient's jawbone, potentially leading to complications or inaccurate implant placement.

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Study Notes

Computer Guided Implantology

  • Definition: Implant placement using a surgical template fabricated using digital maneuvers.
  • Departments involved: Surgery, Radiology, Fixed Prosthodontics, Removable Prosthodontics.

Cast-Based Surgical Guides (Past)

  • Creation Method: Taking an impression of the patient, creating a cast, and fabricating a surgical guide on the cast.
  • Design Variations: Dependent on whether the patient is completely or partially edentulous, the number of implants (single or multiple), and the desire for transparency. A wide variety of designs were possible.
  • Key Limitation: The method only determined the entry point.

Paradigm Shift from 2D to 3D Imaging

  • Transition: From 2D panoramic X-rays to 3D CBCT/CT imaging for implant placement.
  • Advantages of 3D:
    • No superimposition of structures, improving planning accuracy.
    • Increased accuracy of measurements due to the absence of shape distortions.
    • Minimal size distortion compared to 2D radiographs.

Limitations of Cross-Sectional Imaging

  • Increased radiation dose to the patient.
  • Steep learning curve for clinicians.
  • Increased number of images needed.

Transition from Manual to Digital

  • Reduced steps.
  • Time savings.
  • Reduced human intervention, leading to fewer errors.
  • Increased cost.

Transition from Surgically Driven to Prosthetically Driven Implant Placement

  • Sequence: Design the future prosthesis, then perform the surgery based on the prosthesis design.
  • Rationale: A future-oriented approach considers the prosthetic needs for accurate surgical planning.

Advantages of Flapless Technique

  • Shorter chairside time.
  • Reduced surgical skills needed.
  • Reduced post-operative pain and edema.
  • Reduced initial bone resorption.

Advantages of Pre-Operative Planning

  • Predictable outcome.
  • High functional outcome.
  • High aesthetic outcome.
  • High biological outcome.

Steps of Computer-Guided Implant Placement

  • CBCT or MSCT scanning.
  • Treatment planning.
  • Surgical guide design.
  • Surgical guide fabrication.
  • Surgical procedure.

CBCT vs. MSCT Scanning

  • CBCT: Lower radiation dose, interactive software, lower cost, higher spatial resolution
  • MSCT: Better contrast resolution, considered for soft tissues.
  • Voxel size is the primary factor affecting spatial resolution. A smaller voxel size leads to higher resolution.

Field of View (FOV)

  • Customization: CBCT allows for customization to the area of interest.
  • Large FOV Issues: Ethical concerns regarding exposure to unnecessary radiation dose.

Scanning Requirements for Surgical Guide Fabrication

  • Visibility of opposing arches for occlusion confirmation.
  • Separation of arches using a bite material (e.g. radiolucent bite material or cotton rolls).
  • Removal of metal artifacts using image processing algorithms.
  • Noise elimination in CBCT images to improve quality.
  • Covering the area of interest within the scan.

Treatment Planning Using CBCT

  • Implant determination (presence/absence).
  • Graft or sinus lift required.
  • Implantation time (immediate/delayed).
  • Fixed/removable prosthesis.
  • Implant dimensions (length & diameter).
  • Number and distribution of implants and their angulation.

Display Modes

  • Multiplanar reconstruction: Useful for orthogonal views (axial, coronal, sagittal).
  • Oblique multiplanar reconstruction.
  • Panoramic + serial cross-section: Provides an overall view.
  • Volume rendering.
  • Importance of accurate measurements for the surgical guide and the potential risks if they are inaccurate.

Types of Surgical Guides

  • Tooth-supported: Uses existing teeth as support for the guide.
  • Mucosa-supported: Designed for patients with fewer or no teeth, relying on mucosa for support during surgery.
  • Bone-supported: More robust guides that are better for patients with poor bone quality, relying on bone support during surgery.

Levels of CBCT Information Extraction and Implant Simulation

  • Level 1: Extracted anatomical information from CBCT scans (bone height, mesiodistal length, bucco-lingual dimensions, bone morphology, bone density).
  • Level 2: Implant simulation (nerve tracing, implant library, verification).
  • Level 3: Surgical guide design and fabrication.

Scanning Appliances

  • Denture-based: Suitable for fully edentulous patients, critical for accurate implant placement.
  • Vacuum-based: Used for patients with some teeth and potentially missing teeth.
  • Radiopaque markers: Used with dentures or night guards to accurately delineate the relevant regions.

Requirements for Surgical Guide Design

  • CBCT or MSCT scans.
  • Scans of patient's teeth.
  • Scanning appliance (optional).
  • Required scanning protocols.

Disadvantages of Surgical Guides

  • Visibility limitations.
  • Irrigation challenges.
  • Limited mouth opening restrictions.
  • Possible complications in surgical procedure.
  • Added cost.

Additional Key Points

  • Importance of determining the ideal teeth-supported, mucosa-supported, or bone-supported guide based on individual patient criteria.
  • The need for precise pre-surgical planning to ensure the accuracy and success of the final implant placement.

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Computer Guided Implantology PDF

Description

Explore the evolution of implantology from traditional cast-based methods to advanced computer-guided techniques. This quiz covers the roles of various departments, the transition from 2D to 3D imaging, and the benefits of modern implant placement methods. Test your knowledge on key concepts and differences in surgical guide designs.

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