implants - international magazine of oral implantology

I industry report _ TRIPOD procedure Fig. 3b_The Computing TRIPOD. Fig. 4_The position of standardised X-ray opaque resin pins allows the calculation of implant coordinates. Fig. 5a_The drill sleeves being placed in the radiographic template with the transfer table. Fig. 5b_The implant coordinates for the transfer table. Fig. 6_Initial impression of two initially placed implants. Fig. 7_Surgical guide placed on teeth and screwed onto previously placed implants forming the Positioning TRIPOD. Fig. 8_Occlusal guide screwed onto posterior implants. is not required since the large volume of the corre- sponding teeth provides some degree of freedom to the laboratory technician designing the prostheses. These posterior areas often require some bone recon- struction (such as sinus lift or onlay bone grafts), thereby prolonging time to loading. The correspon- ding implants will then ensure not only the most pre- cisepositioningforradiographictemplatesandsurgi- calguides,butalsofortheocclusalguideandimpres- siontray,sinceallthesepartswillbescrew-connected to these previously placed and osseointegrated im- plants. In order to transfer the planned implant posi- tionfromtheplanningsoftwaretothesurgicalguide, aComputingTRIPODisnecessary.ThisComputingTRI- PODismadewiththreeSKYplanXreferencepins(Bre- dent) placed on the radiographic template with the reference plate (Fig. 3a). The patient is scanned with the radiographic template fixed on the Positioning TRIPOD.ThepositionofthestandardisedX-rayopaque referencepinsisdetectedbythesoftware,buildingthe ComputingTRIPOD(Fig.3b),andusedtocalculatethe implantcoordinates(Fig.4).Thisdataisthensetinthe transfertable(Fig.5a)toplacethedrillsleevesaccord- ingly and transfer the radiographic template into a surgical guide (Fig. 5b). Some days prior to the full-arch surgery, once an adequateTRIPODhasalreadybeenplannedandinitial implants placed, an initial impression (Fig. 6) will be takenforthemodeltopreparetheimpressiontray,oc- clusal guide, surgical guide from the radiographic template, as well as the provisional prostheses. The surgical guides are produced in sterilisable resin with radiopaque sleeves (DéPlaque). Special attention is giventotheimpressiontraythatwillextendtoallmax- illarysurfaces,butroomfortheimpressionmaterialis exclusively limited to the planned implant sites. They must be ready at the time of surgery. Onthedayofthesurgery,thepractitionerbeginsby reducing all remaining crowns that would interfere with the surgical guide, which is then placed on teeth orpreferablyscrewedontopreviouslyplacedimplants forming the Positioning TRIPOD (Fig. 7). A CT is per- formed to verify all drilling sites. If any modification has to be done, there is still time to adjust the drill sleeves to adequate positions and to re-sterilise the guide. Thenextstepisthetransferoftheocclusiontothe articulator. Usually an occlusion guide is engineered beforesurgeryandscrewedintoanadequateposition. Itisthenadjustedandsomesiliconematerialisadded 32 I implants3_2011 Fig. 7 Fig. 8Fig. 6 Fig. 4 Fig. 5aFig. 3b Fig. 5b