Dental Tribune United Kingdom

17Implant TribuneAugust 1-7, 2011United Kingdom Edition page 18DTà T he cases presented in this article differ in level of difficulty in order to illustrate that navigated im- plant placement is the proce- dure of choice for many cases. We also wish to demonstrate that template-guided navigated implant placement is advisable not only in very complex cases. From the very first time the pa- tient presents to the dental of- fice, the focus of the entire team contributing to the treatment is on thinking and acting from the patient’s perspective and his or her foremost wish to receive a treatment that is safe, not time- consuming, and associated with as little pain as possible. The advantages of case plan- ning with the NobelGuide soft- ware (Nobel Biocare) in com- bination with template-guided navigated implant placement include: • backward planning • pre-surgical planning in the dental laboratory • maximal certainty of the diag- nosis • minimally invasive interven- tion • evaluation of complications ahead of time, to the extent pos- sible and • optimal prosthetic preparation (Figs. 1–3) As a concept, navigated im- plant placement can even be utilised for the purposes of pa- tient marketing, mainly through word-of-mouth communication, as will become evident in case II. Teamwork The dental laboratory is an im- portant partner in the team working with the NobelGuide software. One of the earliest steps, the preparation of the X-ray tem- plates defining the later pros- thetic targets in detail, is carried out in the laboratory. During the planning phase, the results can be discussed by means of No- belConnect, an Internet-based network of all participating spe- cialists, and the necessary deci- sions concerning the fine-tuning between surgery and later pros- thetic requirements can be made. Accordingly, the resulting case designs were developed on the basis of teamwork and are therefore supported by the entire team. The NobelGuide team always includes the den- tal technician, the prosthetic expert, the surgeon, the patient, and, if applicable, the radiologist recording the 3-D images. The advantages of integrating 3-D di- agnostics, 3-D planning and 3-D templates outweigh the disad- vantages, such as increased ra- diation exposure and associated costs, which are the ones most mentioned. The definite advantages of this approach include certainty of diagnosis, precise surgical im- plementation, avoidance of angu- lar deviations at depth during the surgery, expansion of the range of indications, and prevention of clinical and prosthetic complica- tions to a large degree, especially in the application of NobelActive implants, as is described below. The NobelActive implant system was developed for experienced surgeons in order to be able to attain high primary stability even in compromised bone and under difficult conditions. Two new tools — NobelClini- cian and Nobel Connect — enable even better networking between the participating team partners for collaborative purposes by granting each partner access to the current state of the case—from 3-D planning to the insertion of the implant restoration—through a dedicated software interface. This facilitates communication, especially if team members do not work in the same locale. After taking the history and arriving at a clinical diagnosis, the 3-D analysis is performed and the results are discussed to determine the treatment plan. NobelGuide, being both a surgi- cal and a prosthetic system, is advantageous in that it allows a temporary restoration to be fab- ricated by the dental laboratory prior to surgical intervention, provided this is needed and indi- cated. The laboratory can utilise the drilling template made in a centralised industrial production facility to transfer the planned implant positions to a model such that the temporary resto- ration can be fabricated without From the patient’s perspective Dr Götz Grebe and Dr Melanie Grebe discuss design, implementation and prosthetics Fig 1 Fig 2 Fig 3 Fig 4a Fig 4a Fig 4c Fig 4d Fig 4e Fig 4f Fig 4g Fig 5 Fig 6 Fig 7 Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 13a Fig 13b Fig 4g ‘The dental laboratory is an important partner in the team working with the NobelGuide software’