implants UK - the journal of oral implantology

I 09implants1_2011 case report _ CT-guided implant surgery _Way back in 2005, I was listening to a speaker discuss a new way of placing dental implants that would revolutionise the process. He showed a video ofanelderlySwedishmanstrollingintoadentalclinic with a bag full of ill-fitting dentures, and walking out laterthatsamedaywithfullyimplant-supportedfinal prostheses.Theprocessused3-Dcomputedtomogra- phy (CT) imaging to plan the implant placement, and thenacustomsurgicalguidewasmadethatfacilitated the flapless placement of a dozen or so implants so precisely that only minimal adjustments would be necessary to the prefabricated fixed bridges. The cost of this treatment was about US$100,000, rendering it beyondreachforthemajorityofpatients. This was an enlightening moment for me, as I saw the potential in this technique. As soon as it was available in the US and the cost became more reasonable, I vowed to bring this technology into my practice so that my patients could benefit from this amazinginnovation. Early in 2006, I flew to Chicago and took the Nobel Guide training course, and within a short time I had half a dozen cases under my belt. I was amazed by how quickly and accurately I could place multiple implants, and that most patients needed only a few post-operative ibuprofens and were back at work the nextday.Soonthereafter,IacquiredSimPlantsoftware andbeganusingbothmethodsfortreatmentplanning andplacingimplants. These two pioneering systems opened the door for thecurrenttidalwaveofCT-guidedimplantsurgeries. For those of you not familiar with the concept, CT- guidedimplantsurgeryuses3-DCTimagingtoevalu- atethebonyanatomyoftheedentulousjaw,usesthis forimplantplanning,andthenaccuratelytransfersthe treatmentplantothepatientatsurgeryusingacustom surgical guide that controls the position, angle, and depthofeachdrillandimplantfixture.Itissoaccurate that a custom provisional or even final prosthesis can be made that is delivered with minimal, if any, adjust- mentneeded.Itisapanaceafortherestorativedentist because implant placement is completely prostheti- callydriven,notdictatedbythesurgeon’swhimifthere are anatomical surprises when the tissue is flapped open.Theanatomyisknownwith3-Daccuracybefore surgery, and should bone or tissue augmentation be necessary to position the implants properly, this information is known ahead of time and additional procedures are planned. The result is perfectly placed implants in ideal bone that are straightforward to restoreandfunctionproperlynearlyallofthetime. Even though I did not use CT-guided surgery for every implant case, I probably completed a hundred cases or more in those first two years. It was a very time-consuming process. I had to have the laboratory make a radiographic template, arrange for the patient “Once you’ve tried it, you can’t drink anything else” Author_ Dr Jay B. Reznick Fig. 1 Fig. 2 Fig. 1_Pre-op of failing tooth #10 in a 70-year-old female patient. Fig. 2_Pre-op radiograph showing a horizontal fracture, root canal treatment and a cast post.