implants UK - the journal of oral implantology

I 13 case report _ CT-guided implant surgery I implants1_2011 Fig. 11_Panoramic CBCT recon- struction of a 62-year old male patient missing multiple teeth in the maxilla. Bilateral sinus-lift procedures had been performed six months prior. which can be viewed in an infinite number of cross- sectional cuts. Both types of images are nothing more thanasetofdigitaldatatranslatedintoanimagethat can be viewed on a monitor. Merging these two sets of numbers appears to be a simple process. However, I amnotasoftwareengineer;Iamjustadentist.Luckily for us, there are some smart people at siCAT, Sirona’s software subsidiary in Germany, whose mandate was to do just that. Their efforts have changed implant dentistry forever. With the integration of CEREC and GALILEOS, we now have the opportunity to practise realdigitalimplantology.Therestorationofapatient’s missing dentition can be treatment planned in virtual reality, without the need for physical impressions, pour-up study models or wax-up prostheses. The ability to visualise the patient’s bony- and soft-tissue anatomy in relationship to the proposed prosthesis is a tremendous advantage in attempting to follow the principles of prosthetically driven implant dentistry. Thisfacilitatesrestoration,optimisesfunctionalforces on the implant fixture, and improves long-term im- plantsuccess. AnotherbenefitofCT-guidedimplantsurgeryisthe abilitytoperformtheprocedurethroughaminimalin- cision.Thisispossiblebecausetheunderlying3-Dbony anatomy is known preoperatively. Also, since the sur- gical guide directs the position, angulation and depth of each drill, the surgical time is significantly reduced. This translates to an easier post-operative course for the patient. Because the implant is placed in the ideal position, functional loads on the implant fixture are more ideal. This helps maintain optimal peri-implant bone levels and reduces the failure rate. The resulting timesavedcanbeusedbythesurgeontoschedulean- otherconsultation,surgery,or recreationalactivity. The following cases dem- onstrate the types of implant treatment plans that can be treated using 3-D CT-guided surgical techniques through the integration of GALILEOS andCEREC. _Case I This first patient was a 70-year-old woman with a failingmaxillaryleftlateralincisor.Thetoothhadbeen treated endodontically many years before and had a post-retained fixed prosthesis that was subject to repeated failures (Fig. 1). The tooth was not restorable and a decision was made to remove the tooth and re- placeitwithanimmediatelyplaceddentalimplantand provisional prosthesis (Fig. 2). The patient understood andagreedthattheimmediateimplantandprosthesis wouldnotbeplacedinfunctionforthreemonthsafter placement. A stone study model was made, and the crown of tooth#10wasremoved.Thismodifiedmodelwascap- tured by CEREC in order to create a digital model that representedthesiteaftertoothextraction.Theoppos- ing dentition was captured in a Futar D (Kettenbach) bite registration and the prosthetic proposal was cre- atedinCEREC(Fig.3).Thedigitalmodelandprosthetic proposal were then imported into GALILEOS. The ideal implant size and position were determined within the GALILEOS scan, based on the bony anatomy data, as well as the mucosal surface and prosthetic data from CEREC (Fig. 4). The treatment planning data, along with the stone model and a special scanning template were sent to siCAT, and a custom surgical template wasreturned. This template was used in surgery once the tooth hadbeenatraumaticallyextractedinordertodirectthe placement of the implant fixture into the site of tooth #10. The position, angulation, and depth of implant placementwereallcontrolledbytheguide,sothatthe implantwasplacedexactlywhereithadbeenplanned Fig. 11 Fig.12_3-Dimagereconstruction fromGALILEOSImplantsoftware showingimplantplanningfortooth #15,basedonimportedCEREC virtualmodelandprostheticproposal. Fig.13_3-Dimagerecontructionfrom GALILEOSImplantsoftwareshowing plannignforteeth#2to5,basedon importedCERECvirtualmodeland prostheticproposal. Fig.14_Panoramicreconstructionof CBCTshowingproposedimplantposi- tionsandabutmentscrewpaths.