BDS 11124 Digital technology in implant dentistry.pdf

“Computer aided implant planning and placement” Computer guided planning and surgery It is the selection of implant sites and placement of dental implants employing surgical templates developed with CBCT scans and software programs. Computer guided treatment planning will be the standard of c...

“Computer aided implant planning and placement” Computer guided planning and surgery It is the selection of implant sites and placement of dental implants employing surgical templates developed with CBCT scans and software programs. Computer guided treatment planning will be the standard of care within the next five years Free hand drilling(Previous method) Free hand drilling uses the template to identify the position of the implants. The clinician decides the angulation and depth of the osteotomy preparation. Free hand drilling(Previous method) Disadvantages: Catastrophic mistakes made in position and angulation Injury of vital structures during drilling or implant placement Advantages of computer guided treatment planning and surgery 1. Visualize potential implant sites in 3D in relation to the proposed prosthesis 2. Precise implant placement 3. Less risk of compromising adjacent vital structures 4. Prefabrication of the prosthesis, abutments and immediate loading 5. Enables flapless surgery 1. Visualize potential implant sites in 3D in relation to the proposed prosthesis Allow exact placement of the implant in an ideal position so there are no surprises during surgery or during prosthesis making The patient might not accept any change in the procedure or the type of the final restoration The change in plans might cost the operator more (of course the patient is not obliged to pay for something he wasn’t told about from the start) 2. Flapless surgery Enables Less postsurgical morbidity (pain, swelling etc.) Less chair side time during surgery because: Surgical procedures are minimized Many patients refuse the open surgeries, grafting...etc and will accept the flapless surgeries) 3. Implant distribution Better implant distribution pattern for more favorable biomechanics 4. Precise implant selection proper Selection of an implant of proper Length and diameter according to the available bone width and height 5. Safety Less risk of compromising adjacent vital structures Injury of inferior alveolar nerve Injury of the adjacent root apex 6. Complete digital solutions Using the planning software, we can plan the design : Temporary restoration Customized abutments Final prostheses Steps for computer aided implant planning and placement Diagnosis and Developing a treatment plan Imaging procedures and precautions Importing the DICOM files to planning software Implant planning according to the treatment plan CADing the surgical stent and its printing Using the stent for implant placement Implant planning Virtual implant planning is performed based on a library of the different implants in the software The planner placed the implant of the required size in the proposed site and evaluate the need to modify the position, use a graft, and select the abutment and prosthesis type. Virtual teeth setup This is a step To facilitate the implant planning as the software provides the property of setting virtual teeth to allow visualization of the shape and position of the final restoration and its relation to the planned implant CAD of the surgical guide A special feature is used to construct a virtual design of the guide dictate the position , depth and direction of drilling The CAD file is converted into a real object using 3D printing technology The surgical use of the stent The guide is seated inside the patient mouth and fixed with 3 fixation screws to avoid any movements The operator should drill through the holes of the guide according to the planned location ,depth and direction for osteotomy preparation The implants could be finally placed after the guide is removed or could also be placed through the guide to ensure maximum accuracy Types of stents Tooth supported: used in partially edentulous cases ( rest on natural teeth) Mucosa supported: rest on the mucosa, used in fully edentulous cases Bone supported: Used in dentulous & edentulous cases More stable than mucosa supported A flap should be reflected Types of surgical guides A. Full sequence guides Used with all drills till the final one to control the position, angulation, diameter as well as the depth of the implant osteotomy sites and could be used for implant placement too. This type doesn't offer any of flexibility during surgery to perform hard or soft tissue grafting Usually used in edentulous cases to ensure perfect parallelism between implants Types of surgical guides B. partial sequence guide Employs the same treatment planning software programs as fully guided surgery, but the drill sleeves are designed to accommodate the 2-3 mm pilot drills This results in control only the position, and angulation of the initial osteotomy. , then the rest of drilling is done without a guide Usually used when flexibility is required during surgery as When soft tissue procedures or bone grafting are anticipated during surgery Digital impression for implants Analogue impressions Analogue impression poses many difficulties as: Material tear Tray selection Disinfection Patient discomfort Lab transfer cast inaccuracies Digital implant impression Unlike tooth impressions, implant impressions encounter inherent possible displacements of components, whereas impression copings are connected to implants or replicas. Due to this possible displacement greater errors could be accumulated in impressions of multiple implants than in impressions of single implants. The rise of intraoral scanners and adjunct technology has by passed all these difficulties. Digital Workflow Scan Design Manufacture Direct Digital Workflow Indirect Digital Workflow Digital Workflow Scan Abutment (body) It is a component that attaches to the implant body before digital scanning, it records the exact position and orientation of the implant from the scanned patients mouth or model. Digital work flow Scan body digitization , and scanning using intra-oral scanner. Scan body matching with CAD implant library. Implant analogue repositioned on the virtual model. Cad- Cam Software The software is used to design the desired restoration on the virtual model then it is manufactured using milling technologies form a variety of materials