Guided Implant Surgery Drill Were Placed “Virtually” in the Kit

displacement during the surgical cal guide is worn by the patient tooth-supported guides, mucosa- procedure. during surgery and used to place supported guides and bone-sup- the implants in the same positions, ported guides. The Brown Protocol for depths and angulations as they Guided Implant Surgery Drill were placed “virtually” in the Kit. To use a surgical template for Guided Implant planning software. guided surgery, a special drill kit is Surgery To perform guided surgery, the necessary. This kit may include a clinician needs: tissue punch, drill sleeve and drills Access to a Cone-Beam CT scan- of various lengths and diameters With traditional placement of PDL tm implants, restorations are made ner. These CT scan machines are which are compatible with the spe- after the placement of the implants similar to those used to aid surgeons cific guides and implant manufac- in joint replacement procedures but turers. PerioDontaLetter from maxillary and mandibular I. Stephen Brown, D.D.S., Periodontics & Implant Dentistry Winter arch impressions, a bite registra- utilize much less radiation. tion and diagnostic casts poured Implant Planning Software. Conclusion and mounted on an articulator. Cone beam CT scanners produce In guided surgery, the first step images in a format called Digital Guided surgery using 3-D implant From Our Office is to plan the restoration. Guided Imaging and Communications in patient evaluation and planning has Guided Implant Surgery surgery may permit the placement Medicine (DICOM). Implant plan- opened new horizons for a multidis- to Yours... of a restoration concomitant with ning software reads DICOM files ciplinary, restoratively- and surgi- The introduction of computed uided implant surgery is images of the patient’s jaw bone the insertion of the implants by and reconstructs them in 2-D and/ cally-driven treatment approach, the a procedure in which tomography (CT) technologies and and surrounding tissue makes developing the restorative plan in or 3-D images. These software result of which is accurate and pre- precision surgical instru- possible the most accurate packages provide various tools for dictable placement of dental implants. the rapidly increasing use of cone G concert with the surgical plan. A mentation is used in conjunction approach to implant surgery. beam CT scanning (CBCT) in dental digital or analog diagnostic tooth implant planning allowing the user But the critical factors for suc- with three-dimensional CT The images obtained by com- cess still remain proper diagnosis offices, combined with the use of arrangement indicating the dental to refer to the anatomic structure images. Dedicated computer puterized tomography permit and case selection; the care, skill dedicated dental implant software, anatomy and positions of the teeth of the patient and plan a safe sur- software which allows visual- the implant surgeon to deter- gery. More than a dozen implant and judgment of the clinician; has revolutionized the planning and to be replaced is created. ization and manipulation of the mine the height and width of A scanning prosthesis is placed planning software programs are adherence to surgical and prosthet- placement of dental implants. in the patient’s mouth and a CT/ available, including Anatomage, ic principles; good communication This revolutionary system offers a CBCT scan taken with the patient NobelGuide/NobelClinician, between the implant surgeon and more accurate and safer positioning wearing the prosthesis. The scan Cybermed and SimPlant. the restorative dentist, as well as of dental implants, may reduce the is then imported into a dental soft- A Surgical Template. The sur- patient awareness, education, and time necessary for implant surgery, compliance. ware program which allows the gical template is a laboratory-fab- and may eliminate the need for flap Guided surgery is clearly one of the clinician to “virtually” place the ricated device which references surgery and bone grafts. implants into their ideal positions the surgical planning information. most important advances in implant dentistry. Because it is less invasive Furthermore, it facilitates a team in relation to the restoration and Generally, it is the shape of an approach toward a truly restoratively- underlying anatomy. than conventional implant surgery, orthodontic splint and worn by the and surgically-driven treatment plan. The digital plan is then uploaded patient during surgery. Small people on blood thinners and other medications may now enjoy the ben- This current issue of The via the Internet for guide fabrica- sleeves are inserted into the surgi- efits of implant surgery they could PerioDontaLetter presents an over- tion, permitting a laboratory to cal template to guide the drilling. not have in the past. view of computer-guided technolo- fabricate the surgical guide using Three types of computer-generat- Understanding and adopting by CADCAM technology. The surgi- ed surgical guides are available: gies in dental implant placement, the careful analysis these groundbreak- benefits and drawbacks, indications ing technologies will not only and contraindications, complications change the way dental implants are “Guided surgery is clearly one of the most important and potential errors, and protocols. placed, but will offer patients As always, we welcome your com- advances in implant dentistry." improved predictable outcomes. Figure 1. Guided surgery software allows the clinician to plan ments and suggestions on this giant implant position by virtually placing implants in CT images scanned leap forward in implant surgery. of the patient's jawbone. PDL tm

I. Stephen Brown, D.D.S. 220 South 16th Street, Suite 300 • Philadelphia, PA 19102 • (215) 735-3660 available bone, soft-tissue thick- 1. It is a more precise and 4. Due to extensive planning nesses, the proximity and root accurate procedure for prior to implant placement, anatomy of adjacent teeth, and placing implants. there are fewer unexpected other vital structures in 3-D. findings during surgery. This enables the clinician to 2. Guided surgery preserves choose the correct implant size vital anatomic structures Drawbacks of and position it appropriately in by allowing visualization the arch. of the relationship Guided Implant Image-guided surgery was between the planned Surgery originally developed for neuro- restoration and the bony surgery and is now applied in anatomy. Traditional The primary drawbacks of guid- many medical-dental treatments. surgical guides are ed surgery are: difficult to use predictably when there are no apparent 1. Guided surgery requires the Benefits of surgeon to invest in a anatomic references. Figures 5 and 6. Virtual software planning allows for construction of a precise surgical guide. Guided Implant specialized surgical kit and Surgery 3. The technique may planning software. substantially reduce the Guided implant surgery is a time necessary for implant 2. Treatment planning may take breakthrough technology which surgery. longer than planning for offers benefits previously traditional implant surgery. unknown in implant dentistry.

Figures 7 and 8. Placement of the guide allows for precise, pre-planned surgical positioning of implants.

• Proximity of the proposed Complications and Indications for implants to vital anatomy. Guided Implant Potential Errors • Proximity of the implants to of Guided Implant Surgery adjacent teeth. Figures 2, 3 and 4. A fully edentulous guide Surgery is stabilized with horizontal pins in the Because of its precision and • Questionable bone volume — patient's bone. Following guided drilling, accuracy, guided surgery may bone deficient in width or Complications of guided implant the implants are placed through the guide facilitate implant placement. Its height or with unusual bony surgery are the same as those for holes. many benefits far outweigh the contours. any implant surgical procedure. possible objections of time, radia- Valent et al found the most com- tion exposure and cost. • Flapless implant placement. mon errors are mistaken acquisi- Guided surgery is most beneficial tion of the tomographic image or in the following clinical situations. • Immediate restorations. incorrect processing, deviation of 0.1 to 0.2mm in the fabrication of • Planning for three or more • Significant alteration of soft the surgical guide, inaccurate fix- implants. tissue. ation of the guide resulting in

PerioDontaLetter, Winter available bone, soft-tissue thick- 1. It is a more precise and 4. Due to extensive planning nesses, the proximity and root accurate procedure for prior to implant placement, anatomy of adjacent teeth, and placing implants. there are fewer unexpected other vital structures in 3-D. findings during surgery. This enables the clinician to 2. Guided surgery preserves choose the correct implant size vital anatomic structures Drawbacks of and position it appropriately in by allowing visualization the arch. of the relationship Guided Implant Image-guided surgery was between the planned Surgery originally developed for neuro- restoration and the bony surgery and is now applied in anatomy. Traditional The primary drawbacks of guid- many medical-dental treatments. surgical guides are ed surgery are: difficult to use predictably when there are no apparent 1. Guided surgery requires the Benefits of surgeon to invest in a anatomic references. Figures 5 and 6. Virtual software planning allows for construction of a precise surgical guide. Guided Implant specialized surgical kit and Surgery 3. The technique may planning software. substantially reduce the Guided implant surgery is a time necessary for implant 2. Treatment planning may take breakthrough technology which surgery. longer than planning for offers benefits previously traditional implant surgery. unknown in implant dentistry.

Figures 7 and 8. Placement of the guide allows for precise, pre-planned surgical positioning of implants.

PerioDontaLetter, Winter displacement during the surgical cal guide is worn by the patient tooth-supported guides, mucosa- procedure. during surgery and used to place supported guides and bone-sup- the implants in the same positions, ported guides. Protocol for depths and angulations as they Guided Implant Surgery Drill were placed “virtually” in the Kit. To use a surgical template for Guided Implant planning software. guided surgery, a special drill kit is Surgery To perform guided surgery, the necessary. This kit may include a clinician needs: tissue punch, drill sleeve and drills Access to a Cone-Beam CT scan- of various lengths and diameters With traditional placement of PDL tm implants, restorations are made ner. These CT scan machines are which are compatible with the spe- after the placement of the implants similar to those used to aid surgeons cific guides and implant manufac- in joint replacement procedures but turers. PerioDontaLetter from maxillary and mandibular Winter arch impressions, a bite registra- utilize much less radiation. tion and diagnostic casts poured Implant Planning Software. Conclusion and mounted on an articulator. Cone beam CT scanners produce In guided surgery, the first step images in a format called Digital Guided surgery using 3-D implant From Our Office is to plan the restoration. Guided Imaging and Communications in patient evaluation and planning has Guided Implant Surgery surgery may permit the placement Medicine (DICOM). Implant plan- opened new horizons for a multidis- to Yours... of a restoration concomitant with ning software reads DICOM files ciplinary, restoratively- and surgi- The introduction of computed uided implant surgery is images of the patient’s jaw bone the insertion of the implants by and reconstructs them in 2-D and/ cally-driven treatment approach, the a procedure in which tomography (CT) technologies and and surrounding tissue makes developing the restorative plan in or 3-D images. These software result of which is accurate and pre- precision surgical instru- possible the most accurate packages provide various tools for dictable placement of dental implants. the rapidly increasing use of cone G concert with the surgical plan. A mentation is used in conjunction approach to implant surgery. beam CT scanning (CBCT) in dental digital or analog diagnostic tooth implant planning allowing the user But the critical factors for suc- with three-dimensional CT The images obtained by com- cess still remain proper diagnosis offices, combined with the use of arrangement indicating the dental to refer to the anatomic structure images. Dedicated computer puterized tomography permit and case selection; the care, skill dedicated dental implant software, anatomy and positions of the teeth of the patient and plan a safe sur- software which allows visual- the implant surgeon to deter- gery. More than a dozen implant and judgment of the clinician; has revolutionized the planning and to be replaced is created. ization and manipulation of the mine the height and width of A scanning prosthesis is placed planning software programs are adherence to surgical and prosthet- placement of dental implants. in the patient’s mouth and a CT/ available, including Anatomage, ic principles; good communication This revolutionary system offers a CBCT scan taken with the patient NobelGuide/NobelClinician, between the implant surgeon and more accurate and safer positioning wearing the prosthesis. The scan Cybermed and SimPlant. the restorative dentist, as well as of dental implants, may reduce the is then imported into a dental soft- A Surgical Template. The sur- patient awareness, education, and time necessary for implant surgery, compliance. ware program which allows the gical template is a laboratory-fab- and may eliminate the need for flap Guided surgery is clearly one of the clinician to “virtually” place the ricated device which references surgery and bone grafts. implants into their ideal positions the surgical planning information. most important advances in implant dentistry. Because it is less invasive Furthermore, it facilitates a team in relation to the restoration and Generally, it is the shape of an approach toward a truly restoratively- underlying anatomy. than conventional implant surgery, orthodontic splint and worn by the and surgically-driven treatment plan. The digital plan is then uploaded patient during surgery. Small people on blood thinners and other medications may now enjoy the ben- This current issue of The via the Internet for guide fabrica- sleeves are inserted into the surgi- efits of implant surgery they could PerioDontaLetter presents an over- tion, permitting a laboratory to cal template to guide the drilling. not have in the past. view of computer-guided technolo- fabricate the surgical guide using Three types of computer-generat- Understanding and adopting by CADCAM technology. The surgi- ed surgical guides are available: gies in dental implant placement, the careful analysis these groundbreak- benefits and drawbacks, indications ing technologies will not only and contraindications, complications change the way dental implants are “Guided surgery is clearly one of the most important and potential errors, and protocols. placed, but will offer patients As always, we welcome your com- advances in implant dentistry." improved predictable outcomes. Figure 1. Guided surgery software allows the clinician to plan ments and suggestions on this giant implant position by virtually placing implants in CT images scanned leap forward in implant surgery. of the patient's jawbone. PDL tm

I. Stephen Brown, D.D.S. 220 South 16th Street, Suite 300 • Philadelphia, PA 19102 • (215) 735-3660