implants - international magazine of oral implantology

I industry report _ TRIPOD procedure Figs. 1a–c_Precision positioning of dental implants is mandatory for adequate abutment and screw placement. _Abstract Complete maxillary implant-based bridgework is amongst the most challenging of restorative proce- dures. With TRIPOD, a new treatment protocol for planning and surgery, a radiographic template and a surgical guide are secured to three fixed reference points, such as natural teeth and previously placed dental implants. CT-based software enhances treat- mentbyfirstvalidatingthesurgicalguide,andthenal- lowingchairsidepostmodificationoptions.Open-flap surgery is initiated with sterile templates and impres- siontrays.Implantsitesarepreparedwiththesurgical guide to a final depth with pilot drill and 2.8 mm di- ameterdrill.Furthersitepreparationinvolvesimplant- specificdrills,piezosurgeryandboneexpanders.These developments improve the reliability of complex im- plant-based restorations. _Introduction Immediateloadingofcompletemaxillaryimplant- supported bridgework is an increasing request by pa- tients who have high aesthetic and functional de- mandsandattachgreatimportancetoaneatappear- anceandtheirself-image.Since1977,positiveresults havebeenobtainedinimmediateloading1,2 ,butthese were limited to mandibular, bar-retained removable dentures. In 1997, Tarnow et al.3 published a study showing similar results for maxillary and mandibular full-arch, implant-supported bridgework, and, more recently, the focus has turned to the development of computer-based techniques for improved results. Highly sophisticated technical tools such as Nobel- Guide(NobelBiocare)andtheSAFESurgiGuide®(Ma- terialise Dental) have entered the market and related techniquessuchasAll-on-4(NobelBiocare)arebeing promoted4,5 tohelpmeetpatients’demands.Alltech- niques are based on full maxillary bridgework with a screw-based retention. The screw-retained bridge- workallowsallprocedurestobeperformedduringthe treatment, i.e. impression taking, bridge modification and repair for aesthetic or functional purposes. Amongst the more challenging difficulties in car- rying out such a therapy is implant positioning, espe- cially for a single crown in the anterior region. Precise placement is essential in achieving good aesthetics, phonetics,functionandcleanability.Mostofthetime, implant placement has to be within the limits of 0.5 mm (Fig. 1). Another factor to consider is the pos- siblelossofalveolarboneaftertoothextraction,leav- ingaminimalresidualvolume,andtherebyincreasing the difficulty of the procedure. Thepositioningofimplantsdependsontheguide’s positional accuracy in a definitive place at the time of the surgery and on the accuracy of the guide itself. In TRIPOD—A new proto- col for immediate loading Completemaxillaryimplant-supportedprostheses Author_Dr Jean-Nicolas Hasson, Dr Jacques Hassid & Dominique Fricker, France 30 I implants3_2011 Fig. 1b Fig. 1cFig. 1a