Computer guided implant placement with SimPlant® and Universal SurgiGuide®

Introduction

Today, the first choice for treatment of missing teeth is usually implant based restorations. Earlier, implant treatment was only based on a panoramic X-ray for planning and the experience and intuition of the doctor. Later, planning of implant treatment was based on CT images. Nowadays, implant treatment starts with taking a CT scan, making a planning using the SimPlant^®software, and using a SurgiGuide^® drill guide for performing implant placement.

For teeth restorations, especially of esthetic cases, it is important to fully take into account the periodontal environment when diagnosing and planning. There is a consensus about the fact that controlled periodontal tissue management is based on an understanding of the biological width. Improper management of the periodontal tissue during restorative procedures is a frequent, but often ignored, cause of failure.

The two cases described are implant based restorations for a single tooth, one in the maxilla and one in the mandible.

For both cases, a new type of SurgiGuide^® was used – Universal SurgiGuide^®. With Universal SurgiGuide^®, users of SimPlant^® software can transfer their 3D planning onto their patients with ease and flexibility using only one guide and a set of Drill Keys. Universal SurgiGuide^® provides for easy fixation before surgery, the Drill Keys provide for a flexible drill sequence. Thanks to a special Handle, any angle and any position in the patient’s mouth can be reached. The Universal SurgiGuide^® system is a flexible system, offering a wide selection of diameters and compatibility with drills of any brand.

Case 1: Anterior maxilla

The patient is a 38-year old female of good health. She suffers from periodontal disease, has many endodontic lesions, and poor-quality prosthetic crowns. An implant will be placed at the position of the right upper central incisor which was extracted two months ago at another clinic. A further description of the case can be found hereafter.

1. Initial examination.

2. Panoramic X-ray.

3. A Virtual Tooth was placed at the position of the right upper central incisor to guide the implant planning in order to enhance the esthetic outcome. A tooth-supported Universal SurgiGuide^® drill guide was ordered.

4/5. The images show the tooth-supported Universal SurgiGuide^® drill guide on the plaster cast with the Drill Keys that will be used during surgery (diameters 2.1mm and 2.7mm).

6/7. Pre-operative frontal and occlusal view.

8/9. Frontal and occlusal view after positioning the Universal SurgiGuide^® on the maxilla.

10. Checking the implant direction before placement.

11. Frontal view of the placed implant (Nobel Replace Tapered Groovy 3.5×10mm).

12. A bone graft (Bio-Oss) is placed on the buccal side.

13. The bone graft is covered by an absorbable membrane (Bio-Gide).

14. View of the membrane after suturing.

15/16. Post-operative frontal and occlusal view.

Case 2: Mandible

The patient is a 65-year old female of good health. She suffers from periodontal disease, has many endodontic lesions, and poor-quality prosthetic crowns. Before planning the implant for restoring the left lower first molar, an orthodontic treatment is necessary. A further description of the case can be found hereafter.

1. First examination

2. Panoramic X-ray showing the left lower first molar, which needs to be extracted.

3. Occlusal view after extraction of the left lower first molar and the orthodontic treatment.

4. Final result of the orthodontic treatment, i.e. straightening the arch.

5. After finishing the orthodontic treatment a CT scan is taken in order to perform the implant treatment planning in SimPlant^®. The images show that at the position of the left first molar the mandibular bone is very thin and the tooth to tooth distance is really narrow. Therefore a well planned and accurate implant placement will be the key of success in this case.

6/7. The images show the tooth-supported Universal SurgiGuide^®drill guide on the plaster cast with the Drill Keys that will be used during surgery (diameters 2.1mm and 2.7mm).

8/9. Pre-operative side- and occlusal view.

10/11. View of the Universal SurgiGuide^® in the patient’s mouth.

12. Checking the implant direction before placement.

13. Occlusal view of the placed implant (Nobel Replace Tapered Groovy 3.5×10mm).

14/15. Post-operative result.

Conclusion

Thanks to the technology of SimPlant^® and Universal SurgiGuide^®, the planning of these cases was very easy and a successful operation was ensured. The patients were very satisfied.

Satoshi Kozu,DDS

Kohzu Dental Office
Shirokane Esthetics & Implant Center
#107,1-25-11,Shirokane,Minato-ward,Tokyo,Japan
Tel ＋81-3-5448-9388
Fax ＋81-3-5448-9389

URL http://www.kohzu-dental.com

E-mail info@kohzu-dental.com