Authors of section

Authors

Alexander Schramm, Marc Metzger, Nils Gellrich, Bradley Strong

General Editor

Daniel Buchbinder

Open all credits

Computer assisted dental implant surgery

1. Introduction

Indications

Any planned dental implants can benefit from virtual planning and drill guide construction.

Dental implant prosthetics requires accurate planning and execution. The advantages of using computerized planning is that implants can be three dimensionally placed virtually into locations determined by the prosthetic needs of the patient and available bone volume avoiding critical anatomical structures. Fabrication of drill guides then allows implants to be precisely placed into the desired locations.

2. Preoperative planning

Before 3D-data acquisition, a dental splint is fabricated based on plaster models of the patient. The missing teeth to be implanted are replaced with a barium sulphate-containing polymer based on a setup for simulation of the ideal prosthodontic restoration.

Referencing markers like titanium pins (arrows) are included into the splint. To avoid interference of registration markers and artifacts, the titanium pins should not be placed next to artifact-producing dental fillings and crowns. The second left premolar (arrow) has to be restored. To facilitate virtual implant placement, the ideal implant axis is drilled out of the polymer. The patient wears this splint during CT scanning.

computer assisted dental implant surgery

After completion of the CT scan, the first step is detection of the titanium registration markers (blue).

computer assisted dental implant surgery

Selection and virtual insertion of implants

The dental implant planning software will include a 3D-database that contains various types of dental implants. Depending on the prosthodontic needs, the desired implant is chosen.

Virtual implant insertion is performed using multiplanar views.

The defect in the barium sulfate-containing polymer, showing the ideal implant axis, allows orientation and virtual insertion of the implants according to the prosthodontic requirement.

computer assisted dental implant surgery

In the posterior mandible, the inferior alveolar nerve has to be detected before virtual implant placement.

The ideal implant position for the second molar region in this case is lingual to the alveolar nerve.

computer assisted dental implant surgery

Based on 2D planning alone, as shown in the pseudo panoramic view, implant insertion would not be possible due to the risk of damaging the alveolar nerve. The same concern is shown in the postoperative panoramic X-ray, but because of 3D-guidance, the implant is lingual to the nerve.

computer assisted dental implant surgery

The postoperative panoramic X-ray gives the impression that the implant perforates the mandibular canal. 3D guidance however, guaranteed the preservation of the nerve.

computer assisted dental implant surgery

3D-planning ensures that the implant is covered by bone. If only 2D planning is available, the wrong implant length can be chosen resulting in the implant perforating the lingual cortex into the floor of mouth as seen in the pseudopanoramic X-ray...

computer assisted dental implant surgery

…compared to the 3D-simulation.

computer assisted dental implant surgery

This image shows the correct implant length when the correct prosthodontic axis is planned.

computer assisted dental implant surgery

The size and positioning of drilling and insertion tubes is performed virtually.

These tubes serve as sleeves for guided implant insertion. The type of tubes which have to be used is determined by the implant system.

At the end of the preoperative planning, the position of all the insertion tubes may need to be revised.

The tube position should not interfere with bony structures in open treatment and should not interfere with soft tissue structures in trans gingival implant insertion.

computer assisted dental implant surgery

3. Fabrication of insertion guides

With the coordinates resulting from the virtual planning, holes are drilled into the dental splint and...

computer assisted dental implant surgery

...titanium drilling and insertion tubes are placed.

computer assisted dental implant surgery

Various sizes of drill and insertion guides can now be placed in a defined position inside the titanium tube.

computer assisted dental implant surgery

4. Guided oral implantation

After elevating the mucoperiosteal flap and removal of any osteosynthesis material (after bone grafting) the drill guide is inserted and guided drilling is performed. Each drill diameter can be guided using the different titanium drill sleeves.

computer assisted dental implant surgery

After preparation of all implant sites...

computer assisted dental implant surgery

Guided implant insertion is performed to guarantee correct implant axis in respect to the prosthodontic planning.

computer assisted dental implant surgery

This picture shows the inserted implants.

computer assisted dental implant surgery

5. Prosthodontic restoration

After implant exposure, and any necessary soft tissue procedures, ...

computer assisted dental implant surgery

...titanium abutments are inserted, and prosthodontic restoration is completed.

computer assisted dental implant surgery