implants UK - the journal of oral implantology

I case report_ CT-guided implant surgery 12 I implants1_2011 Fig. 8 _Post-implant cross-sectional CBCT image demonstrating good position and angulation in relationship to provisional prosthesis. Fig. 9 _Tangential slice CBCT showing implant and provisional restoration immedietly after placement. GALILEOS Implant/siCAT system is in the integra- tion of work flow that makes the implant planning phase rapid and effortless. An additional plus is im- provedinventorycontrol.Insteadofrequiringavariety of implant sizes for a single case, the exact fixture di- ameter and length are predetermined, so only a single fixturehastobeorderedpersite. We have traditionally relied on panoramic ra- diographs and study models to plan our implant placement. Surgical stents have always been used in implantology to aid in this process. The traditional surgical guide is made from a wax-up on a stone model that does not allow representation of the true bony anatomy of the underlying edentulous ridge nor the position of adjacent tooth roots. There are various stylesofsurgicalguidesthathavebeeninuse,ranging from thermoplastic sheets to solid acrylic replicas of the final prosthesis. These guides only estimate the position for the initial drill, leaving this up to the dis- cretion of the surgeon, and do not control the depth of drilling. Sequential osteotomies are then generally drilled free hand. This introduces many opportunities for aberrant implant positioning. Even in the hands of the most experienced implant surgeons, up to 20 per cent of implant placements vary from their intended position.Dentistsneedonlylookintheirfavouriteim- plant textbook or journal to find examples of textbook casesthatarelessthanperfect.And,Ihavenevermeta restorativedentistwhohasnothadhisorhershareof similarexperiences. Often,theserestorativechallengescanbemanaged with custom abutments and other prosthetic tricks, which significantly increase the dentist’s laboratory bill and affect the profitability of the case. However, insomecases,theonlysolutioniseithertonotrestore the fixture or to remove it and start over. Anatomical variations also pose challenges, such as a high lingual mylohyoidconcavity,asurprisepneumatisedsinus,or a divergent root that came a little too close to the im- plant fixture. We do not like to have to deal with these complications,buteventhebestofushavefacedthem morethanweliketoadmit. Many of my surgical colleagues are of the opinion that CT-guided surgery is unnecessary because they have been placing implants for many years using the technique they learned 15 or more years ago. I com- pleted my surgical training in 1990, and have done moreimplantsthanIcancountsincethen.Andforthe mostpart,Ihaveaveryhighsuccessrate,withminimal problem cases of which to speak. But, am I perfect? Of coursenot.Aremycolleaguesanybetter?Idon’tthink so. I strongly believe that CT-guided techniques will become the standard of care for implantology within the next ten years, or sooner. Those clinicians reading thisarticlehavealreadydemonstratedanunderstand- ing of what new technologies can do for the practice of dentistry. I’m sure that few of you who own dental CAD/CAM systems could imagine practis- ing without them and the benefits that this technology gives to your patients and your practice. The same holds true for CBCT and guidedimplantsurgery. In September 2009, I was honoured to be the surgeon for the introduction and first live demonstration of the integration of GALILEOS CBCT data with that from a CEREC digital impression and prosthetic proposal. CEREC uses surface-scanning technology to capture a digital impression of the hard and soft tissues around an area where a dental implant is being considered. GALILEOS uses a radiographic source and sensor to image the bonyanatomyintheareaofinterest.Themul- tiple views are then processed by a computer to create a 3-D image of the teeth and bone, Fig. 10 Fig. 8 Fig. 9 Fig. 10 _.Clinical photograph of provisional restoration at three months after surgery.